Department of Paediatric Allergy, Children's Health Ireland at Crumlin, Dublin, Ireland.
Department of Paediatrics and Child Health, Royal College of Surgeons in Ireland, Dublin, Ireland.
Ir J Med Sci. 2024 Feb;193(1):313-319. doi: 10.1007/s11845-023-03414-6. Epub 2023 Jun 7.
Children spend a large proportion of their childhood in schools. In Ireland, there is no government policy on the management of food allergy (FA) in schools or preschool childcare settings (CCS). There is limited data worldwide on rate of accidental allergic reactions (AARs) within these settings.
The aim of this paper is to report the management of FA and the incidence of AARs in Irish school or preschool CCS.
A prospective observational study was established, enrolling children aged 2 to 16 years with confirmed FA. Participants were contacted at three monthly intervals for 1 year to report AARs to food. Data pertaining to schools and preschool CCS is reported here.
A total of 521 children (402 attending school and 119 attending preschool CCS) were enrolled. The annualised incidence of AARs in school was 4.5% (95% CI 2.6-7.0) and in preschool CCS 5% (95% CI 1.8-11.1); 6 of 7 of the nut reactions occurred in schools banning nuts. Half (3/6) of the preschool reactions were to cow's milk; 174/521 (33%) children did not provide their individualised allergy action plan (AAP). Four out of 18 (22%) AARs in school were anaphylaxis and none were administered adrenaline by school staff.
The incidence of AARs in this Irish cohort was found to be equivalent to the international experience. However, many of the recorded reactions identified in this study were likely avoidable. Preparation for AARs needs optimising. The ineffectiveness of "nut bans" remains unrecognised. Promoting milk and egg allergy resolution in infancy would likely reduce preschool- and school-based reaction numbers.
儿童在学校度过了大部分童年时光。在爱尔兰，政府没有针对学校或学前儿童保育机构（CCS）管理食物过敏（FA）的政策。全球范围内，有关这些环境中意外过敏反应（AAR）发生率的数据有限。
本文旨在报告爱尔兰学校或学前 CCS 中 FA 的管理和 AAR 发生率。
建立了一项前瞻性观察性研究，招募了确诊 FA 的 2 至 16 岁儿童。在 1 年内每 3 个月联系参与者一次，报告食物引起的 AAR 数据。这里报告了与学校和学前 CCS 相关的数据。
共纳入 521 名儿童（402 名在学校就读，119 名在学前 CCS 就读）。学校中 AAR 的年发生率为 4.5%（95%CI 2.6-7.0），学前 CCS 中为 5%（95%CI 1.8-11.1）；6 例坚果反应均发生在禁止坚果的学校；3 例（50%）学前反应为牛奶；521 名儿童中，有 174 名（33%）未提供个体化过敏行动计划（AAP）。学校中有 4 例（22%）AAR 为过敏反应，没有学校工作人员给予肾上腺素。
在这项爱尔兰队列研究中发现，AAR 的发生率与国际经验相当。然而，本研究中记录的许多反应很可能是可以避免的。需要优化对 AAR 的准备。“坚果禁令”的无效性仍未被认识到。促进婴幼儿牛奶和鸡蛋过敏的缓解可能会减少学前和学校为基础的反应数量。
