Impact of school peanut-free policies on epinephrine administration

J Allergy Clin Immunol. 2017 Aug;140(2):465-473. doi: 10.1016/j.jaci.2017.01.040. Epub 2017 Mar 25.


Background: Children with food allergies spend a large proportion of time in school but characteristics of allergic reactions in schools are not well studied. Some schools self-designate as peanut-free or have peanut-free areas, but the impact of policies on clinical outcomes has not been evaluated.

Objective: We sought to determine the effect of peanut-free policies on rates of epinephrine administration for allergic reactions in Massachusetts public schools.

Methods: In this retrospective study, we analyzed (1) rates of epinephrine administration in all Massachusetts public schools and (2) Massachusetts public school nurse survey reports of school peanut-free policies from 2006 to 2011 and whether schools self-designated as "peanut-free" based on policies. Rates of epinephrine administration were compared for schools with or without peanut-restrictive policies.

Results: The percentage of schools with peanut-restrictive policies did not change significantly in the study time frame. There was variability in policies used by schools self-designated as peanut-free. No policy was associated with complete absence of allergic reactions. Both self-designated peanut-free schools and schools banning peanuts from being served in school or brought from home reported allergic reactions to nuts. Policies restricting peanuts from home, served in schools, or having peanut-free classrooms did not affect epinephrine administration rates. Schools with peanut-free tables, compared to without, had lower rates of epinephrine administration (incidence rate per 10,000 students 0.2 and 0.6, respectively, P = .009).

Conclusions: These data provide a basis for evidence-based school policies for children with food allergies. Further studies are required before decisions can be made regarding peanut-free policies in schools.

Keywords: Peanut allergy; anaphylaxis; epinephrine; food allergy; school.

MeSH terms

  • Adolescent
  • Anaphylaxis / prevention & control*
  • Arachis*
  • Bronchodilator Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Epinephrine / therapeutic use*
  • Female
  • Food Hypersensitivity / drug therapy*
  • Humans
  • Male
  • Massachusetts
  • Policy*
  • School Health Services / organization & administration
  • Schools


  • Bronchodilator Agents
  • Epinephrine