Survey looks at how schools handle food allergy

NEW YORK (Reuters Health) - A survey of nurses in elementary and middle schools found that food allergy action plans for students with food allergies are used inconsistently.

“I would encourage parents to be proactive with their child’s health and request their physician either provide or recommend a food allergy action plan for their food allergic child,” Dr. John M. Pulcini of University of Mississippi Medical Center in Jackson told Reuters Health.

Food allergy reactions can be life-threatening and are the leading cause of severe allergic reactions, or “anaphylaxis,” outside of the hospital setting, Pulcini noted in a report presented at the annual meeting of the American College of Allergy, Asthma and Immunology underway in Seattle.

There is widespread agreement among various organizations, including specialists in the American College of Allergy, Asthma and Immunology, primary care physicians in the American Academy of Pediatrics, and nurses in the National Association of School Nurses, that food allergy action plans should be in place for all students with food allergies.

“However, there is considerable discrepancy between these recommendations and their actual utilization in schools,” Pulcini said.

He and colleagues surveyed 43, or two thirds, of all elementary and middle school nurses in Greenville County, South Carolina -- the largest public school system in the state - on how food allergy was handled in their schools. All of these nurses worked at schools that had at least one student with food allergies.

A total of 16 food allergy reactions occurred over the previous year with 30 percent of school nurses reporting at least one reaction in the past school year. At least 19 percent of school nurses said they saw at least one food reaction per year, on average.

The findings regarding food allergy action plans “were mixed -- both encouraging in one aspect and discouraging in another,” Pulcini told Reuters Health. Forty-four percent of schools had all food allergic students on action plans - 56 percent did not, he explained.

Forty-two percent of schools in the same district had less than half of their identified food allergic students on food allergy action plans. “Further research is necessary to investigate this discrepancy within a single school system,” Pulcini said.

It’s worth noting, he said, that prior studies in other U.S. school systems have found that 16 percent to 64 percent of food allergic students are on action plans, “so this school system was at or above the current national average.”

In the majority of schools (86 percent), at least three additional school personnel besides the school nurse who were trained to administer food allergy rescue medications, but in 5 percent of schools no other adult was trained to give rescue medication to a student suffering an allergic reaction to food.

Increasing the number of food allergic students who have action plans in schools will require “more cooperation between physicians, school nurses and parents,” Pulcini said. “I believe school nurses have the best intentions for all children at heart and, in my experience, would welcome a food allergy action plan from a physician.”

“Just as many physicians provide guidance to school nurses on children with asthma (such as asthma action plans), I contend physicians need to be prepared to provide guidance to school nurses on the treatment of their patients with food allergies (such as with a food allergy action plan),” he concluded.