Food-induced anaphylaxis in educational settings: Data from the European anaphylaxis registry

Prevention and management of allergic reactions at school are recognized public health concerns. We analyzed food-induced anaphylaxis (FIA) cases which occurred in education facilities to better understand their management.

FIA cases recorded by the European Anaphylaxis Registry which occurred in (pre-)school settings were descriptively analyzed in a comparative manner to pediatric FIA cases that occurred outside education facilities.

Of the 3450 pediatric FIA cases, 332 (9.6%) occurred in education facilities (median age: 4 years [IQR: 2-9]). 151 (45.5%) children had a known allergy to the culprit food. The main culprit foods were peanut (27.4%), hazelnut (12.7%), and cow's milk (9.4%). According to Ring classification, 209 (63.0%) reactions were grade 2, 120 (36.1%) grade 3, and 3 (0.9%; 1 death) grade 4. Adrenaline injection was reported in 50/305 (16.4%) children. Adrenaline use increased from 8.1% to 21.1% of cases during the study period (not statistically significant, p = .68). Compared to children with a FIA outside education facilities, children who experienced FIA in preschool-school settings were more likely to have a known allergy to the culprit food (p <.001) and to have experienced a peanut-induced anaphylaxis (p = .04), and were less likely to receive adrenaline (p <.001).

Anaphylaxis occurring in educational settings can be severe, with frequent known allergy to the culprit food, peanut as the most frequent elicitor, and adrenaline underuse. Action at the national policy level and cross-country collaborations are required to implement a common approach to protect children in educational settings.