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Food allergy in preschool age: Knowledge evaluation of teachers and educational assistants

Food allergy is a potentially fatal condition that can be prevented with allergen avoidance and prompt treatment. It is estimated that, in Europe, 4%– 7% of preschool children have a food allergy,1 and 16%– 18% of children with food allergies have an accidental reaction at school.2 In 2005, the province of Ontario approved Sabrina's law, which regulates the safety of children at risk of anaphylaxis at school, by requiring individual emergency action plans. The circumstance that triggered the relative legislation was the death of a cow's milk allergic teenager after accidental contact with traces of this food at school. In Portugal, the importance of identifying children/students with allergies and/or food intolerances is described in legislative documents. However, there is no regulation on the strategies and guidelines necessary for the safety of these atrisk children. To fill this gap, in May 2012, the Portuguese Society of Paediatric Allergology developed a school training programme for all schools with children at risk of anaphylaxis who are followed in a paediatric allergy consultation. The main objective of our study was to identify knowledge gaps on this topic in teachers and educational assistants and to propose training programme implementation at schools, even in those where there are no identified children with food allergy. This was a crosssectional study based on data collection from the application of questionnaires completed by teachers and educational assistants working with preschoolage children (≤5 years). Participants worked in the national public education network of the Parque Escolar do Agrupamento de Centros de Saúde Porto Ocidental (Porto, Portugal). Questionnaires were designed and contained multiple choice questions assessing food allergy, anaphylaxis knowledge and experience in dealing with it. Participants were advised that their data would be used for the research aim, anonymously. Descriptive statistics were used, and analyses were performed with Statistical Package for the Social Sciences (SPSS) software version 27.0. In total, 112 questionnaires were distributed to nine schools, and 76.8% were answered (Results, Table 1). The majority of the participants thought that they had moderate knowledge on food allergy and considered that anaphylaxis could be managed at school. Participants seemed to be capable to identify the foods most likely involved as food allergens, recognise the need to read food labels and to have the ability to recognise an allergic food reaction/anaphylaxis. However, when asked about their feelings concerning the need to act, if a child with a food allergy had an anaphylactic reaction at school, only 11.7% showed that they felt safe or confident. This is in line with previous studies that demonstrated a lack of knowledge in the diagnosis of and approach to food allergy in school.3 There is no doubt about food allergy has an impact on affected individuals' quality of life and there are many factors that can influence it, notably their age, food allergy severity and reaction history. According to Avery, King, Knight and Hourihane, 2003, who compared the quality of life among children with peanut allergy and children with type 1 diabetes, children with peanut allergy suffer from a greater impact on quality of life and significantly greater anxiety. Surprisingly, 56.1% of the participants thought that students who have food allergy suffered no consequences at school (social, academic or emotional problems) due to their condition. Even if 75% have or already had students with food allergy, almost half of the participants of our study answered that their school did not have an emergency action plan and they did not know that intramuscular adrenaline is the indicated medication to use and how to use it. It has been shown that all schools must have established protocols in order to reduce the incidence of fatal allergic reactions and school training with epinephrine autoinjectors every 6 months should be done to increase adherence to proper technique3,4 The 2019 Chicago Food Allergy Research survey before and after a 1h educational session in six private schools in Houston also showed that a 1h educational session improved knowledge and attitudes in personnel in the intervention schools.5 Our work is descriptive and representative of the reality in schools in the reference area of a Level III Hospital in Portugal's second largest city. These results are an incentive to maintain and frequently renew training in schools, which we currently do in conjunction with the public health team. Study bias: This study was performed on a nonrandomised, small sample, comprising selfreports from teachers and educational assistants.