What is a most important measure for food allergy in nursery?

Problem

As food allergy potentially can induce life-threatening anaphylaxis, measures for food allergy are required at nurseries caring for food allergy children, but a large-scale factual investigation has not been carried out.

Approach

We evaluated measures for food allergy and emergency cases of food allergy children in nurseries. A questionnaire survey regarding emergency measures in all authorized nurseries (411 facilities including 20586 children) was conducted in Kawasaki city, Japan.

Findings

The recovery rate of the questionnaire was 46.5%, which include 14343 children of 191 facilities in total. A total of 637 children (4.4%) in 157 facilities (82.2%) requires elimination diets that were suggested by physicians. Among them, 22 children had been suggested to undergo the use of epinephrine auto-injection kit for emergency. 161 facilities (84.3%) had set a specific manual for emergency of food allergy.Emergency cases over the past one year were four cases and there was no case that had been suggested to use epinephrine auto-injection kit. All were anaphylaxis and the causes of it included two accidental digestion of culprit foods and the causes of other two cases were unknown. A case who required no elimination diet showed first episode of anaphylaxis. All cases were recovered.High percentage of nurseries in Kawasaki city has cared for food allergy children. While many children with food allergy have been in nurseries, only several cases of anaphylaxis has been reported for a one year. Among four cases of anaphylaxis, no specific cause has not be recognized in two cases and one case has been the first episode of anaphylaxis.

Consequences

While most of nurseries have set specific measures for emergency of food allergy, there is certain possibility that nursery staffs can encounter the first episode of anaphylaxis even if there is no food allergy child. For all nurseries, emergency measures for food allergy is vital.