Impact of school peanut-free policies on epinephrine administration

Food allergies are seen in up to 1 in 12 school-age children in the United States today, and peanut is one of the most common allergens.  In response, many schools have started to have peanut-free policies, but the effect of these policies has not yet been rigorously assessed.  In this month’s issue of JACI, Bartnikas and colleagues examine how peanut-free policies affect the rate of potentially fatal allergic reactions to peanut (J Allergy Clin Immunol 2017; 140(2): 465-473).  They looked at 2,223 public schools in Massachusetts during a five-year period, of which 6.3-10.3% banned peanuts from being brought from home, 56.6-59.1% banned peanuts from being served in school, 90.1-91.1% had peanut-free tables and 65.6-67.4% had peanut-free classrooms.  Among these schools, 46 (1.5-2.9%) self-designated as being a “peanut-free school,” but there was considerable variability in how these schools defined a self-designated “peanut-free school,” with 28.9% still allowing peanuts to be brought from home and 4.4% not providing peanut-free tables or classrooms. In the five-year study, 149 students had peanut or tree-nut exposure that required epinephrine, of which two were in self-designated peanut-free schools and one was in a school that did not self-designate as peanut-free but banned peanuts from both being brought from home and served by school.

What they found is that schools with peanut-free tables have lower rates of epinephrine administration, presumably because of fewer life-threatening allergic reactions.  Epinephrine administration rates were not significantly different in schools that had policies restricting peanuts from home, served in schools, or having peanut-free classrooms compared to those that didn’t have such policies. No policy resulted in complete absence of allergic reactions.

The investigators do note that there are limitations to their study.  There may be variability in how policies are interpreted and enforced and not all allergic reactions may have been accounted for if they were not treated with epinephrine.  Nevertheless, this study provides the first evidence to help guide schools in drafting policies regarding peanuts to help better safeguard children with peanut allergy.