Asia Pac Allergy.  2017 Apr;7(2):92-96. 10.5415/apallergy.2017.7.2.92.

Medical certification reduces the number of children requiring allergen elimination diets for school lunches

• Korematsu
• Toyokuni K
• Handa Y
• Gotoh C
• Wasada R
• Kato R
• Kawano N
• Ikeuchi M
• Okamoto T
• Kiriya M
• Takahashi
• Takano T
• Haigo A

• KMID: 2396930
• DOI: http://doi.org/10.5415/apallergy.2017.7.2.92

Abstract

BACKGROUND
Following the increase in the number of children with food allergies, support systems are now required for school lunches, but a large-scale factual investigation has not been carried out.
OBJECTIVE
We evaluated the features of elimination diet due to food allergy and the support system in kindergartens and schools.
METHODS
A prefecture-based questionnaire survey regarding measures for food allergies in school lunches of all kindergartens, public elementary schools, and public junior high schools (631 facilities) was conducted in Oita Prefecture, Japan.
RESULTS
The recovery rate of the questionnaire was 99.5%, which included 106,008 students in total. A total of 1,562 children (1.5%) required elimination diets. The rate of children on elimination diets in kindergartens and elementary/junior high schools that required medical certification by a physician was 1.2% (324 among 27,761 children), which was significantly lower than the 1.8% of children (1,227 among 68,576 students) on elimination diets at the request of guardians without the need for medical certification (p < 0.0001). A total of 43.9% of the kindergartens and schools said that they would contact guardians if symptoms were observed after accidental ingestion, while a low 8.1% stated that they provided support to children themselves, including the administration of adrenaline auto-injectors.
CONCLUSION
Medical certification reduces the number of children requiring elimination diets, but it has not been adequately implemented. Furthermore, waiting to contact guardians after symptoms are observed may lead to the delayed treatment of anaphylaxis. Cooperation between physicians and teachers is desired to avoid the overdiagnosis and undertreatment of children with food allergies.

Keyword

Food allergy; Anaphylaxis; School lunches; Medical certification

MeSH Terms

Anaphylaxis
Certification*
Child*
Diet*
Eating
Epinephrine
Food Hypersensitivity
Humans
Japan
Lunch*
Medical Overuse
Epinephrine

Figure

• 

  Fig. 1 The number and rate of support via elimination diets or elimination and substitution diets in school lunches. The number (rate) of institutions providing support via elimination diets or elimination and substitution diets in school lunches was 120 kindergartens (61.5%), 161 elementary schools (53.5%), and 55 junior high schools (41.7%).

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  Fig. 2 The number and rate of support system in the event of accidental ingestion. Seventy-three kindergartens (37.4%), 135 elementary schools (45.9%), and 68 junior high schools (39.4%) said that they would contact guardians if symptoms were observed after accidental ingestion. However, the number (rate) providing tailored support, including the administration of adrenaline auto-injectors, was low, with responses reported in only 12 kindergartens (6.2%), 30 elementary schools (10.0%), and 9 junior high schools (6.8%). Surprisingly, 21 kindergartens (10.8%), 42 elementary schools (14.0%), and 40 junior high schools (30.3%) responded that they had no plans regarding how to deal with children with food allergies.

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