An Evaluation of Food Allergy Management Practices in a Sample of Canadian and American Schools

Background: Children, including the estimated 7% with food allergy, spend most of their waking hours in school. Variations in school-based food allergy (FA) practices exist. We aimed to examine differences in FA management practices across schools in Canada and the United States (US). Methods: Parents of children with Immunoglobulin E (IgE)-mediated FA were recruited through social media to complete a survey evaluating the schools' stock epinephrine, epinephrine storage locations, school type, and location. Data were described, analyzed using logistic and linear regressions, and then reported as odds ratios (ORs) and standardized coefficients (b), respectively, with corresponding 95% confidence intervals (95%CIs) and p < 0.05. This study was approved by the University of Manitoba Health Research Ethics Board. Results: Overall, 177 participants (14% [26/177] Canada, 86% [151/177] US) were included. Children were, on average, 4.92 ± 3.12 years and were commonly but not mutually exclusively allergic to tree nuts (50% Canada; 40% US) and peanuts (33% Canada; 29% US). Compared to US parents, Canadian parents were more likely to report epinephrine self-carriage by their children (OR = 4.58; 95%CI = 1.67-12.59). Parents with children age > 5 years were more likely to report epinephrine self-carriage by their children (OR = 3.70; 95%CI = 1.38-9.93) but less likely to report that their children's school had an allergen-friendly zone (OR = 0.25; 95%CI = 0.06-0.99). Compared to US parents, Canadian parents were more likely to report their child's school had anaphylaxis management policies (OR = 8.98; 95%CI = 1.11-72.42). Conclusions: Significant in-school FA management differences exist between countries. These findings stress the need for consistent policies and practices to ensure effective care.