Individual healthcare plan for allergic children at school: Lessons from a 2015-2016 school year survey

Background: The individual healthcare plan (IHP) was implemented in schools in France in 2003 to improve management of allergic children. Our objectives were to assess the practical aspects of IHP (excluding asthma) and allergic reactions occurring at school.

Methods: Prospective study conducted in the North Department (France) during the 2015/2016 school year. Two questionnaires were developed: one for the school doctors (n = 67) and one for the school principals (n = 2372).

Results: Data from 336 (25%) of the 1325 IHPs (0.24% of children) were collected (mean age: 8 years; food allergy [FA]: 94% [peanut = 44%, nuts = 54%], venom: 4%). Wide variations in emergency kit (EK) medications were observed: antihistamines (84%), oral corticosteroids (79%), adrenaline auto-injectors (70%), and inhaled bronchodilators (65%). Six hundred and seventy (28%) school principals' responses, representing 81% of all IHPs, were analyzed. A total of 1935 EKs were stored (mean: 2.8/school), one or more with adrenaline, by 213 (32%) schools: in the class room (33%), the nursery (14%), or the principal's office (10%). Sixty, mainly, mild-to-moderate allergic reactions (adrenaline injection: 2) occurred in 44 schools (0.09/school/year), in children with previously undocumented allergy in 50%. FA was highly suspected in 92%.

Conclusion: Individual healthcare plan is mainly implemented for FA. Anaphylaxis remains rare in the school setting, and FA is often a suspected cause of reaction. Staff training should be improved. Application of the recommendations regarding the content and accessibility of EK and a widespread emergency action plan is needed.