Recommendations for the management of food allergies in a preschool/childcare setting and prevention of anaphylaxis

Abstract

Food allergy and anaphylaxis occur most commonly in children under five, the majority of whom attend preschool and early childcare. Children under five differ significantly from school-aged children, as do their care environments, yet specific strategies for managing food allergies in early childcare settings are generally lacking in existing guidelines and legislation. In this review, we outline the scope of the problem, the unique challenges encountered in the preschool environment and existing policy and legislation in Australia, the US, Canada and the UK. We outline the management guidelines and resources available from specialist societies, and the evidence base for specific management strategies including voluntary versus legislative approaches, staff training and education, banning of foods, and availability of multiple and generic adrenaline auto-injectors. We call for greater uniformity and consistency of policy in regards to the recognition and management of infants and children with food allergy in the preschool environment and specific programmes and policies tailored to this environment.

Keywords::

• action plan
• adrenaline auto-injector
• anaphylaxis
• food allergy
• preschool
• risk reduction

Financial & competing interests disclosure

PJ Turner is a recipient of a Clinician Scientist award funded by the UK Medical Research Council. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Food allergy and anaphylaxis is common in the preschool age group and many infants and children attend preschool.

• There are unique challenges in managing the risk of allergic reactions in infants and young children.

• There is a lack of attention to the preschool setting in most national and regional and specialist society guidelines and policy that deal with food allergy in schools.

• Training of staff in the prevention, recognition and management of food allergy in the preschool setting requires regional standardization and specific attention to preschool specific measures.

• Effective training for the prevention, recognition and management of food allergy requires regular re-exposure to education.

• Generic adrenaline autoinjectors are preferable to a requirement that individual food-allergic preschoolers provide multiple devices.

Notes

* Identification of the child at risk of food allergies must minimize the risk of stigmatizing or physically or emotionally ostracizing the child [20].