Table III.
Clinical Information for Students Treated with Epinephrine for Peanut or Tree Nut Exposure.
| Subject number | Age (years) | Gender | Known food allergies | Allergen causing reaction | Source of reaction | Symptoms | Location symptoms developed | Location epinephrine administered | Epinephrine administered by | School Policy | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Self-designated peanut-free school | Peanuts brought from home | Peanuts served by school | Peanut-free tables | Peanut-free classrooms | |||||||||||
| 1 | 8 | Male | Tree nuts | Tree nut | Ate cookie from home containing walnuts | Throat closing | Cafeteria | Nurse’s office | Nurse | Yes | Yes | No | Yes | Yes | |
| 2 | 14 | Female | Peanut | Peanut | Ate peanut butter cookie | Skin (generalized pruritus, flushing, urticaria and/or angioedema); respiratory (rhinorrhea, marked congestion, sensation of throat pruritus and/or tightness in chest or throat PLUS hoarseness, “barky” cough, difficulty swallowing, dyspnea, wheezing and/or cyanosis) | Hallway | Nurse’s office | Nurse | Yes | Yes | No | Yes | Yes | |
| 3 | 8 | Female | Peanut | Peanut | Another student had snack containing peanut butter | Skin (localized pruritus, flushing, urticaria and/or angioedema) | Classroom | Nurse’s office | Nurse | No | No | No | N/A | N/A | |
| 4 | 8 | ND | Nuts | Tree nut | Shared snack containing walnuts/tree nuts with another student | Throat pruritus, progressed to throat closing | Classroom | Nurse’s office | Nurse | No | Yes | No | Yes | Yes | |
| 5 | 11 | ND | None | Peanut | Ate peanuts | Diffuse pruritus, difficulty breathing, shaking and feeling cold | Classroom | Nurse’s office | Nurse | No | Yes | No | Yes | Yes | |
| 6 | 7 | Male | Peanut | Peanut | Ate half of peanut butter and jelly sandwich | Itchy throat and tongue, irregular heart rate | Nurse’s office | Nurse’s office | Nurse | No | Yes | No | Yes | Yes | |
| 7 | 9 | Male | Peanut | Peanut | ND | Respiratory (rhinorrhea, marked congestion, sensation of throat pruritus and/or tightness in chest or throat PLUS hoarseness, “barky” cough, difficulty swallowing, dyspnea, wheezing and/or cyanosis) | Classroom | Nurse’s office | Nurse | No | Yes | No | Yes | Yes | |
| 8 | 7 | Female | Peanut | Peanut | Ate peanut butter | Difficulty swallowing, lip and oropharyngeal angioedema | Cafeteria | Nurse’s office | Nurse | No | Yes | No | Yes | No | |
| 9 | 17 | Female | None | Tree nut | Ate trail mix containing almonds | GI (oral pruritus or “tingling” and/or mild lip swelling PLUS nausea PLUS repetitive vomiting); respiratory (rhinorrhea, marked congestion, sensation of throat pruritus and/or tightness in chest or throat PLUS hoarseness, “barky” cough, difficulty swallowing, dyspnea, wheezing and/or cyanosis) | Classroom | Nurse’s office | Nurse | No | Yes | No | Yes | No | |
| 10 | 15 | Female | Nuts, malt | Peanut | Ate granola bar containing peanut butter | Coughing, chest and throat tightness, difficulty swallowing, oral pruritus, lip swelling | Gym (lunch served in gym) | Nurse’s office | Nurse | No | Yes | No | Yes | No | |
| 11 | 13 | Male | Peanut, tree nuts, kiwi | Tree nut | Ate brownie with walnuts from cafeteria | Respiratory (rhinorrhea, marked congestion, sensation of throat pruritus and/or tightness in chest or throat) | Cafeteria | Nurse’s office | Nurse | No | Yes | No | No | No | |
| 12 | 13 | Female | Peanut | Peanut | Ate half an energy bar containing peanuts | GI (oral pruritus or “tingling” and/or mild lip-swelling PLUS nausea and/or emesis x1); tachycardia | Hallway | Nurse’s office | Nurse | No | Yes | No | No | No | |
| 13 | 8 | Male | Peanut | Peanut | Accidentally took bite of peanut butter and jelly sandwich and spit it out after realizing he ate peanut butter | Tongue and throat pruritus, erythematous rash on neck and face | Cafeteria | Nurse’s office | Nurse | No | Yes | Yes | Yes | Yes | |
| 14 | 6 | ND | Peanut | Peanut | Touched peanut butter in cooking class (family had not informed school of known peanut allergy) | Angioedema of tongue/throat, urticaria | Classroom | Nurse’s office | Nurse | No | Yes | Yes | Yes | Yes | |
| 15 | 5 | Male | Peanut | Peanut | Ate granola bar containing traces of peanuts (child’s mom sent the snack without realizing it contained peanuts) | Wheezing, shortness of breath, periorbital angioedema, rhinorrhea, anxiety | Classroom | Nurse’s office | ND | No | Yes | Yes | Yes | No | |
| 16 | 18 | Male | Fish, shellfish, peanut | Peanut | Ate energy bar containing peanuts | GI (oral pruritus or “tingling” and/or mild lip-swelling PLUS nausea and/or emesis x1) | Locker room | Unknown/other | Self | No | Yes | Yes | Yes | No | |
| 17 | 17 | Female | None | Tree nut | Ate almonds | GI (oral pruritus or “tingling” and/or mild lip-swelling); respiratory (rhinorrhea, marked congestion, sensation of throat pruritus and/or tightness in chest or throat PLUS hoarseness, “barky” cough, difficulty swallowing, dyspnea, wheezing and/or cyanosis) | Walking back from lunch | Nurse’s office | Nurse | No | Yes | Yes | Yes | No | |
| 18 | 12 | Female | Peanut | Peanut | Ate cookie containing peanut butter | Dry mouth | Classroom | ND | ND | No | Yes | Yes | Yes | No | |
| 19 | 13 | Female | Tree nuts | Nut | Ate coffee cake that may have contained nuts | Respiratory (rhinorrhea, marked congestion, sensation of throat pruritus and/or tightness in chest or throat) | Field trip | Field trip | Nurse | No | Yes | Yes | Yes | ND | |
| 20 | 15 | Female | Citrus fruit | Tree nut | Ate almonds the evening prior | Difficulty breathing, chest pressure | Nurse’s office | Nurse’s office | Nurse | No | Yes | Yes | No | No | |
| 21 | 15 | Female | Tree nuts | Nut | Ate nuts the evening prior | Difficulty breathing, throat tightness | Nurse’s office | ND | Nurse | No | Yes | Yes | No | No | |
| 22 | 16 | Female | Tree nuts | Tree nut | Ate chocolate bar containing tree nuts | Urticaria, throat closing | Nurse’s office | Nurse’s office | Nurse | No | Yes | Yes | No | No | |
| 23 | 15 | ND | Peanut, tree nuts | Nut | Nut exposure by possible inhalation | Throat pruritus, chest tightness, chest pressure | Cafeteria | Nurse’s office | Nurse | No | Yes | Yes | No | No | |
| 24 | 15 | Female | Tree nuts, celery | Nut | Ate candy bar containing nuts | Skin (generalized pruritus, flushing, urticaria and/or angioedema); respiratory (rhinorrhea, marked congestion, sensation of throat pruritus and/or tightness in chest or throat PLUS hoarseness, “barky” cough, difficulty swallowing, dyspnea, wheezing and/or cyanosis) | Commons | Nurse’s office | Nurse | No | Yes | Yes | No | No | |
| 25 | 9 | Female | Fish, shellfish, peanut | Peanut | Ate peanut butter in cafeteria | Skin (generalized pruritus, flushing, urticaria and/or angioedema); GI (oral pruritus or “tingling” and/or mild lip-swelling); respiratory (rhinorrhea, marked congestion, sensation of throat pruritus and/or tightness in chest or throat PLUS hoarseness, “barky” cough, difficulty swallowing, dyspnea, wheezing and/or cyanosis) | Classroom | Nurse’s office | Nurse | No | ND | ND | Yes | Yes | |
| 26 | 7 | Male | None | Peanut | Ate peanut butter sandwich | Skin (generalized pruritus, flushing, urticaria and/or angioedema); respiratory (rhinorrhea, marked congestion, sensation of throat pruritus and/or tightness in chest or throat) | Cafeteria | Nurse’s office | Nurse | No | ND | ND | Yes | Yes | |
| 27 | 10 | Male | Peanut | Peanut | Ate granola bar containing peanuts | Difficulty breathing, abdominal discomfort, skin flushing | Classroom | Nurse’s office | Nurse | No | ND | ND | Yes | Yes | |
One hundred and forty-nine students were treated with epinephrine for peanut or tree nut exposure during the five-year study period. Data for the 27 students for which school policy information was available are presented. In most cases, specific allergic reaction symptoms were documented. However, for subjects 2, 3, 7, 9, 11, 16, 17, 19 and 24–26, symptoms are reported in general categories, reflecting that year’s school reporting form documentation.
CV=cardiovascular
GI=gastrointestinal
ND=not documented
N/A=not applicable