乳児院,児童養護施設における食物アレルギー児の在籍状況および給食対応の実態:ガイドライン・マニュアルの有無別の比較

Hisae Mori, Kenji Kuroda

Objectives　To elucidate the actual status of children with food allergies and the measures of allergy-appropriate food provisions at residential nurseries and children's care homes. We also compared institutions that used guidelines, manuals, etc. with those that did not.Methods　Self-administered questionnaires were administered to residential nurseries and children's care homes in Japan. Responses were received from 394 institutions, yielding a response rate of 53.6%. The prevalence of food allergies was assessed in 392 institutions. To investigate the relationship between using guidelines and the status of the children, the analysis included 230 institutions where there were children with food allergies. The relationships between the presence or absence of guidelines and (i) occurrence or non-occurrence of anaphylactic shock or other allergy-related events and (ii) each step of food service were evaluated.Results　The prevalence of food allergies at the 392 institutions was found to be 3.31%. It was difficult to obtain information concerning food allergies at admission to the institutions because a high proportion of children were reported as "children with no physician's diagnostic record," "children admitted without confirmation of allergy information," or "children with discrepancies between the information at admission and actual state."　Of the 230 institutions studied, guidelines were followed at 25.0% of the institutions. Even when institutions with other written rules were included, this proportion only increased to 32.1%. The statistical analysis involved adjustments for different types of institutions. A multivariate logistic regression analysis showed that the odds ratio for institutions where treatment was based on guidelines were significant for the following items: children with no physician's diagnostic record (0.35), existence of a consistent documentation method for collection of information (5.04), regular revisions of information being made (2.85), and reports being submitted when mistakes in food provided to children with allergies were made or narrowly avoided (2.49). In addition, strong correlations were found for the following: children who experienced anaphylactic shock during the previous 3 years (9.72) and children admitted without confirmation of a food allergy (3.12).Conclusions　When rule-based approaches were established, the preparation of information collection forms, revision of information, and reporting of food provision mistakes proceeded more efficiently than when rule-based approaches were not used. Although the prevalence of children experiencing anaphylactic shock and the cases in which information was not confirmed at admission were higher in the institutions using guidelines, this survey revealed that when guidelines were followed, appropriate measures were taken after the admission of children to the institution and that physicians' medical diagnoses were obtained.