The United Kingdom incidence of anaphylaxis has increased very sharply over the last decade, with the highest rates of hospital admissions occurring in school-aged children. This raises concerns about the extent to which schools are aware of approaches to the prevention and treatment of anaphylaxis.
Methods and Findings
We undertook a national postal survey of 250 Scottish schools enquiring about approaches to managing children considered to be at risk of anaphylaxis. We obtained responses from 148 (60%) schools, 90 (61%) of which reported having at least one at risk child. Most (80%) schools with children considered to be at risk reported having personalised care plans and invariably reported having at least one member of staff trained in the emergency treatment of anaphylaxis. Access to adrenaline was available on-site in 97% of these schools. However, significantly fewer schools without children considered to be at risk reported having a trained member of staff (48%, p < 0.001), with access to adrenaline being very poor (12%, p < 0.001). Overall, 59% of respondents did not feel confident in their school's ability to respond in an emergency situation.
Most schools with children considered to be at risk of anaphylaxis report using personal care plans and having a member of staff trained in the use of, and with access to, adrenaline. The picture is, however, less encouraging in schools without known at risk children, both in relation to staff training and access to adrenaline. The majority of schools with at risk children have poorly developed strategies for preventing food-triggered anaphylaxis reactions. There is a need for detailed national guidelines for all schools, which the Scottish Executive must now ensure are developed and implemented.
Schools whose officials know that some of their pupils have serious allergies are often prepared to deal with emergencies, but many don't have good plans for exposure prevention. When there is no knowledge of specific pupils at risk, neither preparedness nor prevention efforts are widespread.
Anaphylaxis is a severe allergic reaction that can cause a drop in blood pressure and swelling of the body tissues (swelling of the neck and throat and narrowing of the airways can make it hard to breathe). The reaction can be triggered by foods, such as peanuts or eggs, or by bee stings, natural latex (rubber), and certain drugs such as penicillin. Foods are the most common trigger in children. In the United Kingdom, thousands of people develop anaphylaxis each year, and the number appears to be increasing. If anaphylaxis is severe, a patient will need to be hospitalized, and the highest risk of hospitalization is in school-aged children. About 20 people die each year in the United Kingdom from anaphylaxis. Anaphylaxis can develop both in people known to have a tendency (risk) of getting the condition and in those with no known risk.
Why Was This Study Done?
The researchers wanted to find out how many school children there were in Scotland with a known risk of developing anaphylaxis. They also wanted to know how many schools were taking steps to minimize these children's risk of getting anaphylaxis during school hours (the risk can be reduced, for example, by prohibiting children from sharing food and eating utensils). Finally, they wanted to find out how many schools had the necessary equipment and trained staff to treat a child that develops anaphylaxis on site.
What Did the Researchers Do and Find?
The researchers sent a questionnaire in the mail to 250 Scottish schools. They received replies from 148 schools, of which 90 reported having at least one child with a known risk of developing anaphylaxis. Most of the schools (80%) that had children at risk had at least one staff member trained to treat anaphylaxis, and 97% of these schools had the drug adrenaline (epinephrine) on site, which is a lifesaving medication for treating anaphylaxis. But many of these schools were doing poorly at reducing the risk of anaphylaxis—for example, only one in three of these schools banned the sharing of eating utensils. Another worrying finding was that among the 58 schools that did not have children known to be at risk of anaphylaxis, less than half had a trained member of staff, and only about one in eight of these schools had adrenaline on site.
What Do These Findings Mean?
It is reassuring that most schools in Scotland that have children known to be at risk of anaphylaxis are well equipped to deal with this emergency if it occurs. But many of these schools are not doing enough to reduce the risk of anaphylaxis occurring. It is worrying that schools that don't have children known to be at risk are often very poorly equipped to deal with anaphylaxis. One weakness of this study is that 102 schools never replied to the questionnaire, so we can't know how well prepared these schools are for dealing with anaphylaxis. Nevertheless, the study suggests that there needs to be detailed guidance for all schools in Scotland on preventing and treating anaphylaxis.
Please access these Web sites via the online version of this summary at http://dx.doi.org/10.1371/journal.pmed.0030326.
NHS Direct page on anaphylaxis
MedlinePlus page on anaphylaxis
Mayo Clinic page on anaphylaxis
Wikipedia entry on anaphylaxis (note: Wikipedia is a free Internet encyclopedia that anyone can edit)