Food allergy and anaphylaxis in a university campus dining program

The estimated prevalence of food allergy (FA) among college students is 15%. However, the risk of FA, anaphylaxis, and related outcomes in college dining halls remains unclear.

We aimed to assess the landscape of food allergens and allergic reactions within a university dining system that offers FA support measures, including stock epinephrine.

This observational study collected data from the incoming 2023 University of Michigan freshman cohort via a survey examining self-reported food-related adverse reactions. We could not determine whether these were true IgE-mediated reactions. Additional self-reported reaction data from 2019 to 2023 were also gathered. To identify common allergens, reactions were categorized by food. Adherence to recipes, label compliance, and use of stock epinephrine were evaluated.

Of 1325 first-year respondents, 492 reported adverse reactions to 847 potential allergens (248 reported reactions to multiple foods). The most common allergens were tree nut (n = 259 [30.5%]), peanut (n = 206 [24.3%]), and wheat (n = 91 [10.7%]). In all, 53 dining hall reactions with symptoms such as emesis, hives, difficulty breathing, and itchy throat were reported. Frequent triggers included tree nut (n = 12 [23.1%]), peanut (n = 7 [11.5%]), and milk (n = 8 [15.4%]). Epinephrine was used by 14 respondents (26%); of those, 10 used personal autoinjectors and 4 used university stock. Recipes linked to tree nut and peanut reactions showed high rates of label (78%) and recipe compliance (89%).

College students with FAs remain at risk for anaphylaxis. While dining halls have enhanced FA support measures, tree nut and peanut continue to be high-risk foods. Stock epinephrine proved to be a crucial, potentially life-saving intervention.