{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,31]],"date-time":"2026-01-31T10:29:29Z","timestamp":1769855369567,"version":"3.49.0"},"reference-count":22,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T00:00:00Z","timestamp":1749513600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 AI143962"],"award-info":[{"award-number":["K23 AI143962"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"University International Partnership and Program Seed Fund (Protudjer)","award":["K23 AI143962"],"award-info":[{"award-number":["K23 AI143962"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Children, including the estimated 7% with food allergy, spend most of their waking hours in school. Variations in school-based food allergy (FA) practices exist. We aimed to examine differences in FA management practices across schools in Canada and the United States (US). Methods: Parents of children with Immunoglobulin E (IgE)-mediated FA were recruited through social media to complete a survey evaluating the schools\u2019 stock epinephrine, epinephrine storage locations, school type, and location. Data were described, analyzed using logistic and linear regressions, and then reported as odds ratios (ORs) and standardized coefficients (b), respectively, with corresponding 95% confidence intervals (95%CIs) and p &lt; 0.05. This study was approved by the University of Manitoba Health Research Ethics Board. Results: Overall, 177 participants (14% [26\/177] Canada, 86% [151\/177] US) were included. Children were, on average, 4.92 \u00b1 3.12 years and were commonly but not mutually exclusively allergic to tree nuts (50% Canada; 40% US) and peanuts (33% Canada; 29% US). Compared to US parents, Canadian parents were more likely to report epinephrine self-carriage by their children (OR = 4.58; 95%CI = 1.67\u201312.59). Parents with children age &gt; 5 years were more likely to report epinephrine self-carriage by their children (OR = 3.70; 95%CI = 1.38\u20139.93) but less likely to report that their children\u2019s school had an allergen-friendly zone (OR = 0.25; 95%CI = 0.06\u20130.99). Compared to US parents, Canadian parents were more likely to report their child\u2019s school had anaphylaxis management policies (OR = 8.98; 95%CI = 1.11\u201372.42). Conclusions: Significant in-school FA management differences exist between countries. These findings stress the need for consistent policies and practices to ensure effective care.<\/jats:p>","DOI":"10.3390\/nu17121971","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T09:59:14Z","timestamp":1749549554000},"page":"1971","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["An Evaluation of Food Allergy Management Practices in a Sample of Canadian and American Schools"],"prefix":"10.3390","volume":"17","author":[{"given":"April","family":"Quill","sequence":"first","affiliation":[{"name":"Department of Statistics, University of Manitoba, Winnipeg, MB R3T 2M5, Canada"},{"name":"Children\u2019s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7426-3386","authenticated-orcid":false,"given":"Michael A.","family":"Golding","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada"},{"name":"Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W2, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5148-3271","authenticated-orcid":false,"given":"Lisa M.","family":"Bartnikas","sequence":"additional","affiliation":[{"name":"Division of Immunology, Department of Medicine, Boston Children\u2019s Hospital, Boston, MA 02115, USA"},{"name":"Harvard Medical School, Harvard University, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3888-8688","authenticated-orcid":false,"given":"Jennifer L. P.","family":"Protudjer","sequence":"additional","affiliation":[{"name":"Children\u2019s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada"},{"name":"Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W2, Canada"},{"name":"Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada"},{"name":"Institute of Environmental Medicine, Karolinska Institutet, 17177 Stockholm, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"790","DOI":"10.1001\/archpedi.155.7.790","article-title":"Food-allergic reactions in schools and preschools","volume":"155","author":"Wood","year":"2001","journal-title":"Arch. Pediatr. Adolesc. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1586\/1744666X.2014.914851","article-title":"Recommendations for the management of food allergies in a preschool\/childcare setting and prevention of anaphylaxis","volume":"10","author":"Ford","year":"2014","journal-title":"Expert. Rev. Clin. Immunol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1016\/j.jaip.2019.10.021","article-title":"Temporal trends in prevalence of food allergy in Canada","volume":"8","author":"Clarke","year":"2020","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1016\/j.jaci.2021.01.034","article-title":"Prevention and management of allergic reactions to food in child care centers and schools: Practice guidelines","volume":"147","author":"Waserman","year":"2021","journal-title":"J. Allergy Clin. Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.anai.2015.05.013","article-title":"Epidemiology and clinical predictors of biphasic reactions in children with anaphylaxis","volume":"115","author":"Alqurashi","year":"2015","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1134","DOI":"10.1542\/peds.2004-1475","article-title":"Administration of Epinephrine for Life-Threatening Allergic Reactions in School Settings","volume":"116","author":"McIntyre","year":"2005","journal-title":"Pediatrics"},{"key":"ref_7","unstructured":"Centers for Disease Control and Prevention (2013). Voluntary Guidelines for Managing Food Allergies in Schools and Early Care and Education Programs."},{"key":"ref_8","unstructured":"Canadian Society of Allergy and Clinical Immunology (2016). Anaphlyaxis in Schools & Other Settings, Canadian Society of Allergy and Clinical Immunology."},{"key":"ref_9","unstructured":"Food Allergy Education and Research (2013). School Guidelines, Food Allergy Education and Research. Available online: https:\/\/www.foodallergy.org\/our-initiatives\/advocacy\/know-your-rights\/school-guidelines."},{"key":"ref_10","unstructured":"Food Allergy Canada (2021). National School Policies, Food Allergy Canada. Available online: https:\/\/foodallergycanada.ca\/professional-resources\/educators\/school-k-to-12\/national-school-policies\/."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Santos, M.J.L., Merrill, K.A., Gerdts, J.D., Ben-Shoshan, M., and Protudjer, J.L.P. (2022). Food Allergy Education and Management in Schools: A Scoping Review on Current Practices and Gaps. Nutrients, 14.","DOI":"10.3390\/nu14040732"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s13223-023-00798-z","article-title":"Winnipeg-based elementary school teachers\u2019 perspectives on food allergy management: A qualitative analysis","volume":"19","author":"Santos","year":"2023","journal-title":"Allergy Asthma Clin. Immunol. Off. J. Can. Soc. Allergy Clin. Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1007\/s11882-016-0663-0","article-title":"Childcare and School Management Issues in Food Allergy","volume":"16","author":"Tsuang","year":"2016","journal-title":"Curr. Allergy Asthma Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"104","DOI":"10.2500\/jfa.2020.2.200023","article-title":"Management of food allergy in the school setting","volume":"2","author":"Huddleston","year":"2020","journal-title":"J. Food Allergy"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.anai.2023.04.003","article-title":"Is epinephrine truly lifesaving, and can we prove this?","volume":"131","author":"Greenhawt","year":"2023","journal-title":"Ann. Allergy Asthma Immunol. Off. Publ. Am. Coll. Allergy Asthma Immunol."},{"key":"ref_16","first-page":"91","article-title":"The evaluation of a food allergy and epinephrine autoinjector training program for personnel who care for children in schools and community settings","volume":"31","author":"Wahl","year":"2015","journal-title":"J. Sch. Nurs. Off. Publ. Natl. Assoc. Sch. Nurses"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/j.anai.2018.06.010","article-title":"Epinephrine auto-injector carriage and use practices among US children, adolescents, and adults","volume":"121","author":"Warren","year":"2018","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_18","unstructured":"Lu, M. (2025, February 11). The Cost of an EpiPen in Major Markets. Visual Capitalist, Available online: https:\/\/www.visualcapitalist.com\/the-cost-of-an-epipen-in-major-markets\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1007\/s11606-022-07694-z","article-title":"Out-of-Pocket Spending on Epinephrine Auto-Injectors Among the Privately Insured, 2015\u20132019","volume":"38","author":"Chua","year":"2023","journal-title":"J. Gen. Intern. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1001\/jamapediatrics.2018.4275","article-title":"Analysis of Value-Based Costs of Undesignated School Stock Epinephrine Policies for Peanut Anaphylaxis","volume":"173","author":"Shaker","year":"2019","journal-title":"JAMA Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2845","DOI":"10.1016\/j.jaip.2020.07.016","article-title":"Managing Food Allergy in Schools During the COVID-19 Pandemic","volume":"8","author":"Greenhawt","year":"2020","journal-title":"J. Allergy Clin. Immunol. Pract."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1016\/j.jaci.2017.01.040","article-title":"Impact of school peanut-free policies on epinephrine administration","volume":"140","author":"Bartnikas","year":"2017","journal-title":"J. Allergy Clin. Immunol."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/12\/1971\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:49:33Z","timestamp":1760032173000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/12\/1971"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,10]]},"references-count":22,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["nu17121971"],"URL":"https:\/\/doi.org\/10.3390\/nu17121971","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,10]]}}}