Preparedness for allergic reactions in Japanese schools: a prefecture-wide survey of school nursing teachers

BACKGROUND: Allergic diseases are common among schoolchildren, and appropriate management within school settings is essential. This study aimed to assess the adequacy of schools' preparedness for managing allergic reactions by investigating both actual cases and measures in place via a cross-sectional survey. METHODS: A questionnaire survey was conducted in all public schools in Gifu Prefecture, Japan. Data were collected on students' allergic diseases, allergy management training, and allergic reactions that occurred at school. Further analysis was conducted to identify factors associated with the implementation of role-playing in training programs for allergy management. RESULTS: Overall, 561 schools with 160,505 students participated in the survey. Among the students, 6.8% and 0.7% had declared food allergies and anaphylaxis, respectively. In total, 775 students (0.5%) were prescribed adrenaline auto-injectors, and 326 schools (58.1%) had students who were prescribed these devices. Allergy response training was conducted at 543 schools (96.8%). While 92.1% of the schools provided practical training on adrenaline auto-injector use, only 45.5% conducted role-playing simulations. The implementation of role-playing was significantly associated with the presence of students who had submitted certificates for school life management related to anaphylaxis (adjusted odds ratio = 1.835). Among the allergic reactions reported at school, 12.1% occurred in students without previous food allergy declarations. CONCLUSIONS: Most schools showed a high level of preparedness through allergy management training. However, to address unexpected reactions, including those in undiagnosed students, simulation or role-playing-based training should be promoted universally.