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. 2017 Aug;140(2):465-473.
doi: 10.1016/j.jaci.2017.01.040. Epub 2017 Mar 25.

Impact of school peanut-free policies on epinephrine administration

Lisa M Bartnikas  1 , Michelle F Huffaker  2 , William J Sheehan  1 , Watcharoot Kanchongkittiphon  3 , Carter R Petty  4 , Robert Leibowitz  5 , Marissa Hauptman  1 , Michael C Young  1 , Wanda Phipatanakul  6
Affiliations

Impact of school peanut-free policies on epinephrine administration

Lisa M Bartnikas et al. J Allergy Clin Immunol. 2017 Aug.

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.

Keywords: Peanut allergy; anaphylaxis; epinephrine; food allergy; school.

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Figures

Figure 1
Figure 1. Epinephrine Administration for Peanut or Tree Nut Exposure by School Year
Incidence rate of epinephrine administration by school year for peanut or tree nut reactions. From 2006–2011, epinephrine administration increased each year on average by 23% for reactions to peanut or tree nut (P<0.001).
Figure 2
Figure 2. Policies in Self-Designated Peanut-Free Schools
During the five-year study period, 46 schools identified as self-designated peanut-free and complete specific policy information was supplied for 45.
Figure 3
Figure 3. Epinephrine Administration for Peanut or Tree Nut Reactions by School Policy
Incidence rate of epinephrine administration by policy pooled from 2006–2011. Number of schools with a given policy pooled from 2006–2011 are indicated.
See this image and copyright information in PMC

Comment in

  • Peanut-free schools: What does it really mean, and are they necessary?
    Stukus DR. Stukus DR. J Allergy Clin Immunol. 2017 Aug;140(2):391-392. doi: 10.1016/j.jaci.2017.03.037. Epub 2017 Apr 25. J Allergy Clin Immunol. 2017. PMID: 28454741 No abstract available.
  • Epinephrine use as a measure of successful food allergy management.
    Ford LS, Tyquin BK, Treloar MJ, Kakakios AM, Campbell DE. Ford LS, et al. J Allergy Clin Immunol. 2017 Oct;140(4):1213-1214. doi: 10.1016/j.jaci.2017.06.035. Epub 2017 Aug 23. J Allergy Clin Immunol. 2017. PMID: 28844496 No abstract available.
  • Reply.
    Bartnikas LM, Young MC, Phipatanakul W. Bartnikas LM, et al. J Allergy Clin Immunol. 2017 Oct;140(4):1214-1215. doi: 10.1016/j.jaci.2017.06.034. Epub 2017 Aug 23. J Allergy Clin Immunol. 2017. PMID: 28844497 No abstract available.

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