"Parents need to meet with school officials to discuss any food allergies, assess the school's level of preparedness and provide any added measures necessary to make the child's school environment as safe as possible," says Robert Wood, M.D., associate professor of pediatrics at Johns Hopkins and lead investigator of the study. "They should provide instructions from their physician as well as epinephrine."
Wood and his colleagues embarked on the study because little is known about the risk of food-allergy attacks in school and pre-school. They recruited children ages 3 to 19 from patients seen at The Johns Hopkins Hospital and from private pediatric offices in the Baltimore metropolitan area and in Virginia. With parental consent, the researchers interviewed school officials, parents of younger children and teenagers. Of 132 children, 18 percent experienced one or more allergic reactions in school, with milk and peanut being the most common culprit. Symptoms ranged from skin rashes to wheezing, vomiting, diarrhea and hypotension. Fifteen percent were treated with epinephrine.
"Eighteen percent is high enough that there is potential for significant improvement," says Wood. Various factors were linked to reactions, including cafeteria errors, food sharing by children and classroom parties where cupcakes, for example, had traces of peanut oil, an allergy- attack trigger for many.
The researchers also found that roughly 15 percent of the children had no physician order for treatment or medication. Most schools cannot give epinephrine without a physician order and medicine provided by a parent.
"In some situations, parents were not proactive enough in providing medication and information to the school; in others, the school lapsed," says Wood. "Sometimes, physicians were not forceful enough in recommending that the medication be taken to school. The ultimate responsibility, however, falls on the parent."
All children with food allergies need a clear emergency plan and medications available in school in case of a reaction. Parents may want their child to wear a medical alert bracelet, says Wood. Training materials are available from the Food Allergy Network. And schools should put one person in charge of handling an allergic reaction and designate a backup person.
Other authors of the study are Anna Nowak-Wegrzyn, M.D., and Mary Kay-Conover Walker. The National Institutes of Health and the Eudowood Foundation for the Consumptives of Maryland funded the study. For more information about food allergies, visit http://www.hopkins-allergy.org and http://www.foodallergy.org.
Archives of Pediatrics and Adolescent Medicine 2001;155:790-795
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