title: Acute and preventive management of anaphylaxis in German primary school and kindergarten children.
abstract: BACKGROUND
  Anaphylaxis is a severe, life-threatening situation. However, little is known about real-life anaphylactic management in children, especially in kindergarten and school settings, where a large number of anaphylaxes take place.
  
  
  METHODS
  Parents, school teachers and child-care providers of 86 primary schools and kindergartens in the city of Dresden, Germany, received questionnaires to report their experience with anaphylaxis in children. The main foci of interest were symptoms, allergens, sites of occurrence, acute treatment and emergency sets.
  
  
  RESULTS
  Out of 6352 returned questionnaires, 87 cases of anaphylaxis were identified. Prevalence was calculated at 1.5%. Average age of the patients was 7 years, 58% were boys. The majority of reactions occurred at home (67%/58 children). Fourty seven percent (41 children) had recurrent episodes of anaphylaxis. Eighty two percent (71 children) showed cutaneous symptoms, 40% (35 children) respiratory symptoms, 29% (25 children) gastrointestinal symptoms, and 3.4% (3 children) cardiovascular symptoms. Fourty seven percent were classified as mild reactions. Foods were the most common cause (60%/52 cases). Out of these 52, tree-nuts (23%/12 cases) and peanuts (16%/8 cases) were the most frequent triggers. Sixty percent (52 cases) of reactions were treated by a physician, 35% (30 cases) were treated by non-medical professionals only. Fifty one percent (44 children) received antihistamines, 37% (32 children) corticosteroids, 1% (1 child) intramuscular adrenaline. Sixty one percent of children (53 cases) received an emergency kit. Content were corticosteroids (70%/37 cases) and antihistamines (62%/33 cases). Adrenaline auto-injectors were prescribed to 26% (14 cases). Concerning school and kindergarten-staff, 13% of the child-care providers had no knowledge about the emergency kit's content, compared to 34% of teachers.
  
  
  CONCLUSIONS
  This study might support the impression of severe under-treatment of anaphylactic children in the use of adrenaline and prescription of incomplete equipped emergency sets. Knowledge of school and kindergarten staff must be improved through enhanced education.
authors.affiliation: Pediatric Department, TU Dresden, University Hospital Carl Gustav Carus Dresden, Dresden, Germany. magdalena.kilger@gmail.com.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Kilger
authors.affiliation: Institute for Medical Informatics and Biometry (IMB), Medical Faculty Carl Gustav Carus, Dresden, Germany. ursula.range@tu-dresden.de.
authors.forename: Ursula
authors.initials: U
authors.lastname: Range
authors.affiliation: Pediatric Department, TU Dresden, University Hospital Carl Gustav Carus Dresden, Dresden, Germany. christian.vogelberg@uniklinikum-dresden.de.
authors.forename: Christian
authors.initials: C
authors.lastname: Vogelberg
mesh_terms: D000707:Anaphylaxis / Q000453:epidemiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D019468:Disease Management; D004630:Emergencies; D005178:Faculty / Q000592:standards*; D005260:Female; D005858:Germany / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012574:Schools; D011795:Surveys and Questionnaires; D014505:Urban Population