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Factors influencing accidental food allergic reactions in schools and preschools
Miranda Crealey1,2, Aideen Byrne3,4,5
1Department of Paediatric Allergy, Children's Health Ireland at Crumlin, Dublin, Ireland. mirandacrealey@rcsi.ie.
Insights
Accidental allergic reactions (AARs) in Irish schools and preschools occur at rates similar to international data. Many food allergy reactions were preventable, highlighting the need for better management and preparation in childcare settings.
Area of Science:
- Pediatric Allergy
- Public Health Policy
- Food Safety in Educational Settings
Background:
- Ireland lacks government policy for managing food allergy (FA) in schools and preschools.
- Limited global data exists on the incidence of accidental allergic reactions (AARs) in these settings.
Purpose of the Study:
- To report on the management of food allergy (FA) and the incidence of accidental allergic reactions (AARs) in Irish schools and preschool childcare settings (CCS).
Main Methods:
- Prospective observational study of 521 children aged 2-16 years with confirmed FA.
- Children were monitored for one year, with data collected on AARs in school and preschool CCS.
- Analysis focused on reaction incidence, triggers, and management, including allergy action plans (AAPs).
Main Results:
- Annualised incidence of AARs was 4.5% in schools and 5% in preschools.
- A significant number of nut reactions occurred despite schools banning nuts.
- Many children lacked individualized allergy action plans, and school staff did not administer adrenaline during anaphylaxis events.
Conclusions:
- Food allergy reaction rates in Ireland are comparable to international figures.
- Many AARs in schools and preschools are avoidable, indicating a need for improved management strategies.
- Current 'nut ban' policies appear ineffective, and early resolution of milk and egg allergies could reduce reaction incidence.
Background:
Children spend a large proportion of their childhood in schools. In Ireland, there is no government policy on the management of food allergy (FA) in schools or preschool childcare settings (CCS). There is limited data worldwide on rate of accidental allergic reactions (AARs) within these settings.
Aim:
The aim of this paper is to report the management of FA and the incidence of AARs in Irish school or preschool CCS.
Methods:
A prospective observational study was established, enrolling children aged 2 to 16 years with confirmed FA. Participants were contacted at three monthly intervals for 1 year to report AARs to food. Data pertaining to schools and preschool CCS is reported here.
Results:
A total of 521 children (402 attending school and 119 attending preschool CCS) were enrolled. The annualised incidence of AARs in school was 4.5% (95% CI 2.6-7.0) and in preschool CCS 5% (95% CI 1.8-11.1); 6 of 7 of the nut reactions occurred in schools banning nuts. Half (3/6) of the preschool reactions were to cow's milk; 174/521 (33%) children did not provide their individualised allergy action plan (AAP). Four out of 18 (22%) AARs in school were anaphylaxis and none were administered adrenaline by school staff.
Conclusion:
The incidence of AARs in this Irish cohort was found to be equivalent to the international experience. However, many of the recorded reactions identified in this study were likely avoidable. Preparation for AARs needs optimising. The ineffectiveness of "nut bans" remains unrecognised. Promoting milk and egg allergy resolution in infancy would likely reduce preschool- and school-based reaction numbers.
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