title: Food Allergy Trends and Epinephrine Autoinjector Presence in Summer Camps.
abstract: BACKGROUND
  Pediatric campers with food allergies are at greater risk for exposure and anaphylaxis. A diagnosis of asthma increases risk for anaphylaxis. Epidemiological investigations of food-allergic children at high risk for allergic reactions requiring intervention in camp settings are lacking.
  
  
  OBJECTIVE
  The objectives of this study were to estimate the prevalence of food allergies among otherwise healthy campers in summer camps throughout the United States and Canada, and to assess asthma comorbidity and determine rates of epinephrine autoinjector prescriptions present in this population.
  
  
  METHODS
  We partnered with CampDoc.com, a web-based camp electronic health record system. Deidentified data were abstracted from 170 camps representing 122,424 campers. Only food allergies with a parental report of symptoms requiring intervention or with a camp prescription for an epinephrine autoinjector were included, whereas gluten, lactose intolerance, and food dyes were excluded. Asthma status and epinephrine presence on the camp medication list were assessed.
  
  
  RESULTS
  Overall, 2.5% of campers (n = 3055) had documented food allergies. Of these campers, 22% had multiple food allergies. Median age was 11 years; 52% were female. Nuts (81%), seafood (17.4%), egg (8.5%), fruit (8.1%), and seeds (7.2%) were the top 5 food allergies reported. Of food-allergic campers, 44.3% had concurrent asthma and 34.7% of those campers were taking multiple asthma medications. Less than half (39.7%) of food-allergic children brought an epinephrine autoinjector to the camp.
  
  
  CONCLUSIONS
  Life-saving epinephrine is not necessarily available for food-allergic children in camp settings. A substantial proportion of food-allergic campers are at higher risk for anaphylaxis based on concurrent asthma status.
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, Mich. Electronic address: nschellpfeffer@gmail.com.
authors.forename: Natalie R
authors.initials: NR
authors.lastname: Schellpfeffer
authors.affiliation: Department of Health Behavior and Education, School of Public Health, University of Michigan, Ann Arbor, Mich.
authors.forename: Harvey L
authors.initials: HL
authors.lastname: Leo
authors.affiliation: Department of Pediatrics, St. Joseph Mercy Hospital, Ann Arbor, Mich.
authors.forename: Michael
authors.initials: M
authors.lastname: Ambrose
authors.affiliation: Department of Emergency Medicine, University of Michigan, Ann Arbor, Mich.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Hashikawa
mesh_terms: D000707:Anaphylaxis / Q000453:epidemiology* / Q000517:prevention & control; D001249:Asthma / Q000453:epidemiology*; D002165:Camping; D002170:Canada / Q000453:epidemiology; D002648:Child; D057286:Electronic Health Records; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology*; D006801:Humans; D007267:Injections; D008297:Male; D010988:Play and Playthings; D044382:Population Groups; D015995:Prevalence; D012306:Risk; D012651:Self Medication; D014481:United States / Q000453:epidemiology
chemical_list: D004837:Epinephrine
keywords: Allergy; Anaphylaxis; Asthma; Emergency care; Epinephrine autoinjector; Pediatric; Summer camp; Urgent care