Purpose of the Study. To describe clinical features of allergic reactions to peanuts and tree nuts occurring in school or day care environments.
Study Population. Participants were from the US National Peanut and Tree Nut Allergy Registry (PAR), which is a voluntary, self-reported, or parental reported registry of individuals who are allergic to peanuts and/or tree nuts. This group of individuals from the database had experienced peanut and/or tree nut allergic reactions in a school or day care setting.
Methods. One hundred subjects were randomly selected from the PAR database and telephone interviews were performed to characterize the number of allergic reactions, causative food, initial symptoms, severity of final reactions, method of food contact, and the treatment rendered/school response.
Results. Of 4586 total database registrants, 750 (16%) reported allergic reactions to peanuts and/or tree nuts while in school or day care. One hundred subjects or parental surrogates described 115 reactions to peanuts and 9 reactions to tree nuts. For 25% of these subjects, a school reaction was the first indication of peanut or tree nut allergy. A total of 32% had 1 prior reaction, 37% had 2, 11% had 3 and 20% had >3 prior reactions. A total of 64% occurred in preschool with the remainder in elementary school or higher. Mode of contact included 60% occurring from ingestion, 24% from skin contact/possible ingestion, and 16% from inhalation/possible skin contact or ingestion. Peanut butter craft projects accounted for the most common ingestion. Treatment was given in 90% of reactions. Antihistamines were given in 84% and epinephrine in 28%. Epinephrine was administered by teachers, nurses, parents, and others. A nurse was on location for only 23% of reactions. Treatment delays were secondary to delayed recognition of reactions, calling parents, not following emergency plans, and, in 1 case, inability to administer self-injectable epinephrine.
Conclusions. Peanut and tree nut allergic reactions are common in school and day care environments. Both accidental exposures and new onset reactions can occur. School personnel need to be educated to recognize and treat food-allergic reactions.
Reviewers’ Comments. There are 2 weakness from this article that stem from the reliance on self-reported information. First, this could represent an overestimation of severity of school peanut and tree nut reactions as described in the article. Second, when nonmedically trained personnel report such events, reliability and historical recall need to be taken into account. However, in the school and day care environment, nonmedically trained personnel will be the first to recognize signs and symptoms of allergic reactions and therefore need to be educated regarding food allergies. Successful management includes prevention, prompt recognition, availability of medications, written emergency plans, and early administration of epinephrine by teachers, nurses, parents, cafeteria workers, and other school and day care personnel.
- Sicherer SH, Furlong TJ, DeSimone J, Sampson HA. J Pediatr.2000;138 :560– 565
- Copyright © 2002 by the American Academy of Pediatrics