Recognition, evaluation, and treatment of anaphylaxis in the child care setting

Background: Anaphylaxis can occur anywhere. Many young children with a history of allergic reactions or anaphylaxis spend considerable time in child care centers. However, little is known about the centers' knowledge of, experience with, and capability to manage anaphylaxis. Objective: To evaluate the ability of child care centers to recognize, evaluate, and treat anaphylactic episodes in children aged 1 to 6 years. Methods: Eighty-five child care centers in the suburbs of Chicago were randomly selected. They were contacted by telephone and asked to participate in a study by completing an initial questionnaire. Center directors and teachers were then offered an allergy seminar addressing anaphylaxis avoidance, recognition, evaluation, and treatment. Center directors completed a questionnaire after the seminar. Results: Forty-four of the 85 centers contacted agreed to participate. Forty-two surveys were completed before the seminar and 39 after the seminar. On average, each center has up to 7 children with an identifiable food allergy. Information provided by the parents was the most commonly reported source of education concerning allergies. Before seminar completion, only 24% of child care centers would administer intramuscular epinephrine for a severe allergic reaction. After the seminar, 77% of centers stated that they would administer intramuscular epinephrine (P < .001). Also, center staff significantly improved their knowledge of typical allergy symptoms and of the correct method of intramuscular epinephrine administration. Conclusions: There is a need for greater anaphylaxis education among child care providers. Our intervention significantly increased the ability of child care staff to recognize, evaluate, and treat anaphylaxis.