Prevention and management of allergic reactions to food in child care centers and schools: Practice guidelines - 05/05/21
Doi : 10.1016/j.jaci.2021.01.034
Susan Waserman, MD, MSc a, ⁎ 
, Heather Cruickshank, BA a, Kyla J. Hildebrand, MD, MSsCH b, Douglas Mack, MD a, Laura Bantock, RN c, Theresa Bingemann, MD d, e, Derek K. Chu, MD, PhD a, Carlos Cuello-Garcia, MD, PhD f, g, Motohiro Ebisawa, MD, PhD h, David Fahmy, MD a, David M. Fleischer, MD i, j, Lisa Galloway, BA, BEd k, Greg Gartrell, MA k, Matthew Greenhawt, MD j, Nicola Hamilton, RN ▪, Jonathan Hourihane, MD l, m, Michael Langlois, CES, CHSC, CRSP n, Richard Loh, MD o, Antonella Muraro, MD, PhD p, Lana Rosenfield, MD q, Sally Schoessler, MSEd, BSN, RN, AE-C r, Mimi L.K. Tang, MD s, t, Brenda Weitzner, MD u, Julie Wang, MD v, Jan L. Brozek, MD, PhD a, f
, Heather Cruickshank, BA a, Kyla J. Hildebrand, MD, MSsCH b, Douglas Mack, MD a, Laura Bantock, RN c, Theresa Bingemann, MD d, e, Derek K. Chu, MD, PhD a, Carlos Cuello-Garcia, MD, PhD f, g, Motohiro Ebisawa, MD, PhD h, David Fahmy, MD a, David M. Fleischer, MD i, j, Lisa Galloway, BA, BEd k, Greg Gartrell, MA k, Matthew Greenhawt, MD j, Nicola Hamilton, RN ▪, Jonathan Hourihane, MD l, m, Michael Langlois, CES, CHSC, CRSP n, Richard Loh, MD o, Antonella Muraro, MD, PhD p, Lana Rosenfield, MD q, Sally Schoessler, MSEd, BSN, RN, AE-C r, Mimi L.K. Tang, MD s, t, Brenda Weitzner, MD u, Julie Wang, MD v, Jan L. Brozek, MD, PhD a, f a Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
b Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
c Department of Primary Medical Services, Sun Peaks Community Health Centre, Sun Peaks, British Columbia, Canada
d Department of Allergy and Immunology, Rochester Regional Health, Rochester, NY
e Division of Allergy, Immunology, and Rheumatology, University of Rochester, Rochester, NY
f Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
g Quality in Health Care Residency Program, Tecnologico de Monterrey School of Medicine, Monterrey, Mexico
h Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, National Hospital Organization, Sagamihara, Kanagawa, Japan
i Department of Pediatrics-Allergy/Immunology, University of Colorado School of Medicine, Aurora, Colo
j Department of Allergy and Immunology, Children's Hospital Colorado, Aurora, Colo
k School District No. 73, Kamloops, British Columbia, Canada
l Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
m Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
n District School Board of Niagara, St Catharines, Ontario, Canada
o Department of Immunology, Princess Margaret Hospital for Children, Subiaco, Australia
p Food Allergy Centre, University of Padua, Padua, Italy
q Section of Allergy and Clinical Immunology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
r Allergy and Asthma Network, Vienna, Va
s Department of Paediatrics, The University of Melbourne, Melbourne, Australia
t Murdoch Children’s Research Institute, Royal Children's Hospital, Melbourne, Australia
u Department of Family Medicine, University of Toronto, Toronto, Ontario, Canada
v Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
∗Corresponding author: Susan Waserman, MD, Health Sciences Centre, Room 3V49, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.Health Sciences CentreRoom 3V49McMaster University1280 Main Street WestHamiltonONL8S 4K1Canada
Abstract |
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.
Le texte complet de cet article est disponible en PDF.Key words : Food allergy, food hypersensitivity, schools, school teachers, child care, child day care centers, health education, epinephrine, secondary prevention, practice guidelines
Abbreviation used : GRADE
Plan
| Supporting organizations include the Allergy and Asthma Network; the American Academy of Allergy, Asthma & Immunology; the American College of Allergy, Asthma and Immunology; the Canadian Society of Allergy and Clinical Immunology; and the World Allergy Organization. |
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| Declaration of funding: This work was supported by the Allergy, Genes and Environment Network (AllerGen), a federally funded research network established by Innovation, Science and Economic Development Canada through the Network of Centres of Excellent (NCE). AllerGen contributed Can$50,000 to this project, which was used to remunerate the research coordinator and support the costs of hosting a guideline panel meeting in Atlanta, Ga, USA. |
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| Disclosure of potential conflict of interest: Some of the authors have professional affiliations or personal interests outside of the submitted work that are related to the topic of allergy. During the development of these guidelines, an external committee was asked to review each research team and panel member’s anonymized disclosure of interests. Panel members who were deemed to have a real, perceived, or potential conflict of interest were asked to abstain from voting on recommendations related to that interest. S. Waserman has received research support from Pfizer; has served as an advisory board member for Aralez, Mylan, Pediapharm, and Pfizer Canada; and has served as an advisory board member for Food Allergy Canada. H. Cruickshank works as a freelance writer for Healthline Media and was previously employed by Food Allergy Canada, which receives financial support from pharmaceutical and food industry partners. K. J. Hildebrand has served as a consultant in the development of patient and child care education materials for Food Allergy Canada; has received an honorarium for reviewing patient education materials for Health Canada; has received a research grant from the Canadian Allergy, Asthma, and Immunology Foundation; and is a member of the board of directors of the Canadian Society of Allergy and Clinical Immunology. D. Mack has served as a consultant in the development of anaphylaxis-related educational programs for Pfizer and Sanofi; has served as a consultant for Kaleo and Pediapharm; has served as an advisory board member for Pfizer, Allerject, and Bausch Health; has provided food allergy–related consultation to the City of Hamilton and Ontario Human Rights Commission; and has provided expert witness testimony on food allergy in schools to the Ontario Human Rights Tribunal. L. Bantock was previously employed by Food Allergy Canada, which receives financial support from pharmaceutical and food industry partners. T. Bingemann is the co-chair of the food allergy and epinephrine in schools workgroup and the psychosocial issues in food allergy workgroup of the American Academy of Asthma, Allergy, and Immunology’s Adverse Reactions to Food Committee; the vice chair of the American Academy of Asthma, Allergy, and Immunology’s Anaphylaxis Committee; and a member of the American College of Allergy, Asthma and Immunology’s Dermatology Committee, the American Academy of Pediatrics’ Section of Allergy and Immunology Executive Committee, the Asthma and Allergy Foundation of America’s Food Allergy/Anaphylaxis Subcommittee, and the International Food Protein–Induced Enterocolitis Syndrome Association’s medical advisory board. D. K. Chu is a Canadian Allergy, Asthma, and Immunology Foundation–Canadian Society of Allergy and Clinical Immunology–AllerGen Emerging Clinician-Scientist Research Fellow, supported by the Canadian Allergy, Asthma, and Immunology Foundation; the Canadian Society of Allergy and Clinical Immunology; and AllerGen Inc, Networks of Centres of Excellence. C. Cuello Garcia has received travel support from the World Allergy Organization and has received an honorarium as an expert consultant for the American College of Rheumatology and the American College of Physicians. M. Ebisawa has served as a scientific advisory board member for DBV Technologies and has received speaker’s fees from DBV Technologies, Thermo Fisher, and Pfizer. D. Fahmy has received speaker’s fees from Novartis and Aralez. D. M. Fleischer has received research support from Aimmune Therapeutics and DBV Technologies; has received royalties from UpToDate; has served as a consultant to AllerGenis, Aquestive, Aravax, DBV Technologies, Genentech, Intrommune, and Nasus; and has served as a member of the clinical advisory board of Food Allergy Research and Education, the medical advisory board of the Food Allergy and Anaphylaxis Connection Team, the medical advisory council of the National Peanut Board, the Adverse Reactions to Food Committee of the American Academy of Allergy, Asthma and Immunology, and the Food Allergy Committee of the American College of Allergy, Asthma and Immunology. M. Greenhawt has received research grants from DBV Technologies and the Agency for Healthcare Research and Quality; has served as a consultant for the Canadian Transportation Agency, Aimmune and Intrommune; has received speaker’s fees from Aimmune, DBV Technologies, Nutricia, ReachMD, Thermo Fisher, and multiple patient organizations and medical societies; has served as a medical advisory board member for Aimmune, DBV Technologies, Kaleo, Nestle, Nutricia, Monsanto, and the Food Allergy and Anaphylaxis Connection Team; is a member of the medical advisory board of Kids with Food Allergies/Asthma and the Allergy Foundation of America; is a member of the scientific advisory council of the National Peanut Board; is the chair of the Food Allergy Committee and a member of the Adverse Reactions to Foods Committee of the American College of Allergy, Asthma and Immunology; is a member of the Joint Taskforce on Allergy Practice Parameters; is a member of the expert panel on peanut allergy prevention of the National Institute of Allergy and Infectious Diseases; is an associate editor for the Annals of Allergy, Asthma, and Immunology; and has provided expert witness testimony on stock epinephrine laws to the Michigan State Legislature. N. Hamilton is a partner in the company Vancouver Food Machinery. J. Hourihane has served as a consultant and received research funding from Aimmune; has received research funding and speaker’s fees from DBV Technologies; and is the president of the Irish Association of Allergy and Immunology and the chair of Irish Food Allergy Network, both of which receive unrestricted educational grants from industry sources. R. Loh has received travel and accommodation support from Mylan and is a past-president of the Australasian Society of Clinical Immunology and Allergy, which has received an unrestricted grant from Mylan and Alphapharm. A. Muraro has received speaker’s fees from Aimmune, DBV Technologies, Nestle Health Institute, and Nutricia. S. Schoessler is employed by the Allergy and Asthma Network, which receives financial support from pharmaceutical and food industry partners. M. L. K. Tang is the inventor on a patent owned by Murdoch Children’s Research Institute for a method of inducing tolerance to peanut; has served as a consultant for the Government of Victoria in the development of legislation, position statements, and publications related to the prevention and management of anaphylaxis in public schools and children’s services; is a member of the Anaphylaxis Committee of the Australasian Society of Clinical Immunology and Allergy and has contributed to the organization’s development of national food allergy guidelines; is a member of the medical advisory board of Anaphylaxis and Allergy Australia; has received research funding from the National Health Medical Resource Council of Australia, Murdoch Children’s Research Institute, Abbott Nutrition, Bayer Pharmaceuticals, and Prota Therapeutics; has acted as a consultant to Bayer Pharmaceuticals; and has received speaker’s fees from Abbott Nutrition and Nestle Health Science. J. Wang has participated in an advisory board meeting with DBV Technologies and Genentech; has acted as a site investigator on clinical trials supported by Aimmune, DBV Technologies, Regeneron, and the National Institutes of Health; is a member of the Joint Task Force on Practice Parameters; is the vice chair of the Anaphylaxis, Dermatitis, Drug Allergy Interest Section of the American Academy of Allergy, Asthma and Immunology; and is the chair of the Executive Committee of the Section on Allergy and Immunology of the American Academy of Pediatrics. J. L. Brozek has received research contracts from the World Allergy Organization and the Allergic Rhinitis and its Impact on Asthma initiative. The rest of the authors declare that they have no relevant conflicts of interests. In addition to the interests disclosed, some authors have food allergy or children with food allergy. This information was disclosed to the external committee that reviewed panel members’ conflicts of interests, and the committee determined that people or have food allergy or children with food allergy should abstain from voting on the final recommendations. We have not disclosed the names of those panel members here in order to maintain the confidentiality of private medical information. |
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Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 147 - N° 5
P. 1561-1578 - mai 2021 Retour au numéro
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