title: Impact of school peanut-free policies on epinephrine administration.
abstract: BACKGROUND
  Children with food allergies spend a large proportion of time in school but characteristics of allergic reactions in schools are not well studied. Some schools self-designate as peanut-free or have peanut-free areas, but the impact of policies on clinical outcomes has not been evaluated.
  
  
  OBJECTIVE
  We sought to determine the effect of peanut-free policies on rates of epinephrine administration for allergic reactions in Massachusetts public schools.
  
  
  METHODS
  In this retrospective study, we analyzed (1) rates of epinephrine administration in all Massachusetts public schools and (2) Massachusetts public school nurse survey reports of school peanut-free policies from 2006 to 2011 and whether schools self-designated as "peanut-free" based on policies. Rates of epinephrine administration were compared for schools with or without peanut-restrictive policies.
  
  
  RESULTS
  The percentage of schools with peanut-restrictive policies did not change significantly in the study time frame. There was variability in policies used by schools self-designated as peanut-free. No policy was associated with complete absence of allergic reactions. Both self-designated peanut-free schools and schools banning peanuts from being served in school or brought from home reported allergic reactions to nuts. Policies restricting peanuts from home, served in schools, or having peanut-free classrooms did not affect epinephrine administration rates. Schools with peanut-free tables, compared to without, had lower rates of epinephrine administration (incidence rate per 10,000 students 0.2 and 0.6, respectively, P = .009).
  
  
  CONCLUSIONS
  These data provide a basis for evidence-based school policies for children with food allergies. Further studies are required before decisions can be made regarding peanut-free policies in schools.
authors.affiliation: Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Bartnikas
authors.affiliation: Stanford University Medical Center, Stanford, Calif.
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Huffaker
authors.affiliation: Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
authors.forename: William J
authors.initials: WJ
authors.lastname: Sheehan
authors.affiliation: Children's Hospital of Michigan, Detroit, Mich.
authors.forename: Watcharoot
authors.initials: W
authors.lastname: Kanchongkittiphon
authors.affiliation: Boston Children's Hospital, Boston, Mass.
authors.forename: Carter R
authors.initials: CR
authors.lastname: Petty
authors.affiliation: School Health Unit, Division of Primary Care and Health Access, Boston, Mass.
authors.forename: Robert
authors.initials: R
authors.lastname: Leibowitz
authors.affiliation: Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
authors.forename: Marissa
authors.initials: M
authors.lastname: Hauptman
authors.affiliation: Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Young
authors.affiliation: Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass. Electronic address: wanda.phipatanakul@childrens.harvard.edu.
authors.forename: Wanda
authors.initials: W
authors.lastname: Phipatanakul
mesh_terms: D000293:Adolescent; D000707:Anaphylaxis / Q000517:prevention & control*; D010367:Arachis; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005512:Food Hypersensitivity / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008404:Massachusetts; D057766:Policy; D012572:School Health Services / Q000458:organization & administration; D012574:Schools
chemical_list: D001993:Bronchodilator Agents; D004837:Epinephrine
keywords: Peanut allergy; anaphylaxis; epinephrine; food allergy; school