Food allergy management has become an important issue with the rise of food allergies in the world. Food allergy affects up to 8% of school age children and management has become a major public health issue. Consensus guidelines recommend that all students at risk for anaphylaxis due to food allergy have an individualized emergency action plan as well as an epinephrine auto injector at all times (EpiPen, Auvi-Q, AdrenaClick). Few studies have evaluated the percentage of children with emergency action plans and epinephrine auto injectors at school.
A recent study published in the Annals of Allergy Asthma and Immunology evaluated the percentage of students who had emergency action plans and epinephrine auto injectors in a suburban school district.
Over 5000 student were evaluated in a school. 8.33% had food allergies (418 students)
- 56.2% of them had peanut allergy
- 46.9% tree nut allergy
- 13.9% cow milk allergy
- 11.0% egg allergy
- 10.8% shellfish allergy
- 43% reported an allergy to other foods, including sesame, wheat, soy and various fruits.
In grades K-5, the percentage of students with emergency action plans was 70% as compared to 67% of students in grades 6-8. For grades 9-12, 1.8% of students had an emergency action plan, significantly lower than the other grades.
In terms of student who had an injectable epinephrine:
- K-5, 85%
- Grades 6-8, 67%
- Grades 9-12, 48%
In this study, the food allergy management protocols were much lower for the higher grades. Grades 9-12, were less likely to have a food allergy action plan and have epinephrine auto injectors. This goes along with the blog post we posted earlier that adolescents are at a higher risk of anaphylaxis.
The lower percentage of students with action plans and injectable epinephrine in the higher grades may reflect a decreasing parental vigilance as children grow older and progress through the school system. It may also reflect the consequences of the shifting responsibility of food allergy management from parents to adolescents.
Adolescents have poorer outcomes from food allergy anaphylaxis due to risk taking behavior regarding dietary intake and failure to carry an auto-injector. Schools need to target high school students to improve adherence and management of food allergy guidelines.
In California it is now mandatory that all schools be stocked with injectable epinephrine.