Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
J Allergy Clin Immunol. 2021 May;147(5):1561-1578. doi: 10.1016/j.jaci.2021.01.034.
Food allergy management in child care centers and schools is a controversial topic, for which evidence-based guidance is needed. Following the Grading of Recommendations Assessment, Development, and Evaluation approach, we conducted systematic literature reviews of the anticipated health effects of selected interventions for managing food allergy in child care centers and schools; we compiled data about the costs, feasibility, acceptability, and effects on health equity of the selected interventions; and we developed the following conditional recommendations: we suggest that child care centers and schools implement allergy training and action plans; we suggest that they use epinephrine (adrenaline) to treat suspected anaphylaxis; we suggest that they stock unassigned epinephrine autoinjectors, instead of requiring students to supply their own personal autoinjectors to be stored on site for designated at-school use; and we suggest that they do not implement site-wide food prohibitions (eg, "nut-free" schools) or allergen-restricted zones (eg, "milk-free" tables), except in the special circumstances identified in this document. The recommendations are labeled "conditional" due to the low quality of available evidence. More research is needed to determine with greater certainty which interventions are likely to be the most beneficial. Policymakers might need to adapt the recommendations to fit local circumstances.
儿童保健中心和学校的食物过敏管理是一个有争议的话题，需要循证指导。我们采用推荐评估、制定和评估分级方法，对管理儿童保健中心和学校食物过敏的选定干预措施的预期健康影响进行了系统的文献回顾；我们汇编了有关选定干预措施的成本、可行性、可接受性和对健康公平影响的数据；并制定了以下有条件建议：我们建议儿童保健中心和学校实施过敏培训和行动计划；我们建议他们使用肾上腺素（肾上腺素）治疗疑似过敏反应；我们建议他们储备未分配的肾上腺素自动注射器，而不是要求学生提供自己的个人自动注射器存放在现场，以便指定在校使用；我们建议他们不要实施全面的食物禁令（例如，“无坚果”学校）或过敏原限制区（例如，“无奶”餐桌），除非在本文档中确定的特殊情况下。由于现有证据质量较低，这些建议被标记为“有条件”。需要更多的研究来更确定地确定哪些干预措施最有可能有益。政策制定者可能需要根据当地情况调整建议。
