Bartnikas Lisa M, Huffaker Michelle F, Sheehan William J, Kanchongkittiphon Watcharoot, Petty Carter R, Leibowitz Robert, Hauptman Marissa, Young Michael C, Phipatanakul Wanda
Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
Stanford University Medical Center, Stanford, Calif.
J Allergy Clin Immunol. 2017 Aug;140(2):465-473. doi: 10.1016/j.jaci.2017.01.040. Epub 2017 Mar 25.
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.
We sought to determine the effect of peanut-free policies on rates of epinephrine administration for allergic reactions in Massachusetts public schools.
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.
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).
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.
患有食物过敏的儿童大部分时间在学校，但学校过敏反应的特征尚未得到充分研究。一些学校自行指定为无花生学校或设有无花生区域，但这些政策对临床结果的影响尚未得到评估。
我们试图确定无花生政策对马萨诸塞州公立学校过敏反应肾上腺素给药率的影响。
在这项回顾性研究中，我们分析了（1）马萨诸塞州所有公立学校的肾上腺素给药率，以及（2）2006年至2011年马萨诸塞州公立学校护士关于学校无花生政策的调查报告，以及学校是否根据政策自行指定为“无花生”。比较了有无花生限制政策的学校的肾上腺素给药率。
在研究时间段内，实施花生限制政策的学校百分比没有显著变化。自行指定为无花生的学校所采用的政策存在差异。没有一项政策与过敏反应完全不存在相关。自行指定的无花生学校以及禁止在学校提供或从家中带来花生的学校都报告了坚果过敏反应。限制从家中带花生、在学校提供花生或设有无花生教室的政策并未影响肾上腺素给药率。设有无花生餐桌的学校与没有的相比，肾上腺素给药率较低（每10,000名学生的发病率分别为0.2和0.6，P = 0.009）。
这些数据为制定针对食物过敏儿童的循证学校政策提供了依据。在就学校的无花生政策做出决策之前，还需要进一步研究。
