The US Peanut and Tree Nut Allergy Registry: characteristics of reactions in schools and day care.
OBJECTIVE
Severe food-allergic reactions occur in schools, but the features have not been described.


METHODS
Participants in the US Peanut and Tree Nut Allergy Registry (PAR) who indicated that their child experienced an allergic reaction in school or day care were randomly selected for a telephone interview conducted with a structured questionnaire.


RESULTS
Of 4586 participants in the PAR, 750 (16%) indicated a reaction in school or day care, and 100 subjects or parental surrogates described 124 reactions to peanut (115) or tree nuts (9); 64% of the reactions occurred in day care or preschool, and the remainder in elementary school or higher grades. Reactions were reported from ingestion (60%), skin contact/possible ingestion (24%), and inhalation/possible skin contact or ingestion (16%). In the majority of reactions caused by inhalation, concomitant ingestion/skin contact could not be ruled out. Various foods caused reactions by ingestion, but peanut butter craft projects were commonly responsible for the skin contact (44%) or inhalation (41%) reactions. For 90% of reactions, medications were given (86% antihistamines, 28% epinephrine). Epinephrine was given in school by teachers in 4 cases, nurses in 7, and parents or others in the remainder. Treatment delays were attributed to delayed recognition of reactions, calling parents, not following emergency plans, and an unsuccessful attempt to administer epinephrine.


CONCLUSIONS
School personnel must be educated to recognize and treat food-allergic reactions. Awareness must be increased to avoid accidental exposures, including exposure from peanut butter craft projects.
Sicherer
S H
SH
Division of Pediatric Allergy/Immunology, Department of Pediatrics, Elliot and Roslyn Jaffe Food Allergy Institute, Mount Sinai School of Medicine, New York, New York; and Food Allergy Network, Fairfax, Virginia.
Furlong
T J
TJ
DeSimone
J
J
Sampson
H A
HA
D000293:Adolescent; D000328:Adult; D010367:Arachis / Q000009:adverse effects*; D001364:Awareness; D002648:Child; D002656:Child Day Care Centers; D002675:Child, Preschool; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D005512:Food Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D009754:Nuts / Q000009:adverse effects*; D012042:Registries; D012307:Risk Factors; D012574:Schools; D014481:United States / Q000453:epidemiology
D004837:Epinephrine