Food allergy and gastrointestinal disease
Impact of school peanut-free policies on epinephrine administration

https://doi.org/10.1016/j.jaci.2017.01.040Get rights and content

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.

Section snippets

Determination of epinephrine administration in schools

After administering epinephrine, all Massachusetts school nurses must complete and submit a standardized data collection form (see Fig E1 in this article's Online Repository at www.jacionline.org)10 to the Massachusetts Department of Public Health (MDPH). Reporting of epinephrine administration in all Massachusetts schools became mandatory in November 2003 under 105 CMR 210, the Regulations Governing the Administration of Prescription Medications in Public and Private Schools. Nurses completing

School epinephrine administration

The number of students enrolled in Massachusetts public schools per academic year (AY) was publicly available: 968,661 students in 1,875 schools during AY 2006-2007; 962,806 students in 1,870 schools during AY 2007-2008; 958,910 students in 1,846 schools during AY 2008-2009; 975,053 students in 1,831 schools during AY 2009-2010; and 955,563 students in 1,824 schools during AY 2010-2011.

The number of times epinephrine was administered each year for all causes was 138 during AY 2006-2007, 117

Discussion

Our study is the first examining epinephrine administration rates for peanut and tree nut reactions in schools over time, and rates are increasing. Although Banerjee et al9 demonstrated that peanut-free classrooms were associated with decreased lunch peanut content, no studies have examined clinical outcomes of schools' peanut-free policies. This is a crucial public policy question that must be addressed, especially as rates of food allergy and anaphylaxis to peanuts and tree nuts in schools

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    This research is supported by the National Institutes of Health (NIH grant nos. R01 AI 073964, U01 AI 110397, and K24 AI 106822; PI, W.P.; grant no. K23 AI 104780; PI, W.J.S.) and an NIH Pediatric Research Loan Repayment Program grant (grant no. L40 AI 113590; PI, L.M.B.). Funding was provided by The Allergy and Asthma Awareness Initiative, Inc. This work was conducted with support from Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award no. UL1 TR001102) and financial contributions from Harvard University and its affiliated academic health care centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic health care centers, or the NIH.

    Disclosure of potential conflict of interest: M. F. Huffaker has been employed by Brigham and Women's Hospital and Stanford University and has received a travel grant from Teva. M. Hauptman has received grants from the Agency for Toxic Substances Disease Registry (ATSDR of the Centers for Disease Control and Prevention) (grant no. FAIN U61TS000237), the Environmental Protection Agency (grant no. DW-75-92301301), and the National Institute for Environmental Health Sciences (grant no. P30-ES000002). M. C. Young is employed by South Shore Allergy and Asthma Specialists, PC and has received royalties from Quarto Publishing. The rest of the authors declare that they have no relevant conflicts of interest.

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