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New National Push to Improve Anaphylaxis Response in Childcare Centers, with Alice Hoyt, MD
HCPLive spoke with Hoyt about the new Early Childhood Anaphylaxis Collaborative, which strives to educate early childcare centers on how to recognize and respond to anaphylaxis.
Last week, a multi-disciplinary group of healthcare providers and childcare professionals met to discuss how to best provide early childcare centers with resources to recognize and respond to severe allergic reactions in young children.1
The Early Childhood Anaphylaxis Collaborative, spearheaded by Kaléo, strives to educate people on gaps in recognizing anaphylaxis in children < 5 years and provide guidance on stocking epinephrine that is not prescribed to a specific child. Founding partners include Allergic Living, Association for Early Learning Leaders, Asthma and Allergy Foundation of America, Code Ana, Elijah-Alavi Foundation, Food Allergy & Anaphylaxis Connection Team, and Kids with Food Allergies.
Approximately 12 million children ≤ 5 years attend childcare in the US, and up to one-third of food allergic reactions at these centers or schools occur without a food allergy diagnosis.2,3 Many people do not realize that anaphylaxis presents differently in young children than older children or that a child might not experience reactions after the first exposure to a food but could on a later date.
Food allergies are the most common in children < 6 years. Frequent food allergens in this age category include milk, egg, peanuts, tree nuts, sesame, shellfish, soy, wheat, and fish. Research has found that 40% of children with food allergies are allergic to ≥ 2 foods.
In an interview with HCPLive, Alice Hoyt, MD, FAAAAI, chief allergist at the Hoyt Institute of Food Allergies and chair of founding partner Code Ana, emphasized the importance of this initiative due to the rising prevalence of pediatric food allergies and childcare center professionals not having anaphylaxis training or access to stock epinephrine.
According to Food Allergy Research & Education (FARE), the food allergy prevalence has been rising for decades, increasing 50% between 1997 and 2011 and again by 50% between 2007 and 2021.4
“I know that when I was a little girl, I knew 1 person who had a food allergy, and now it is multiple children that I know of,” Hoyt said. “[It’s] not just because I do food allergy, but being a mom, multiple kiddos have food allergies now in my kid’s classes, and so helping these early childcare centers be prepared is just something we have to do.”
People started reporting food allergies in the 1990s, and it wasn’t until the 1990s that people saw an uptick in peanut allergy. The uptick led experts to recommend avoiding common allergens until a certain age, advice not backed by research. In the year 2000, experts recommended that babies avoid cow milk until 1 year old, eggs until 2 years, and peanuts, tree nuts, and shellfish until 3 years.
“What we saw as a result of that delayed introduction of allergens is an even bigger increase in food allergy,” Hoyt said.
Around 2015, a study showed that early introduction of peanuts could significantly reduce the likelihood of infants developing a peanut allergy.5
Hoyt said a large gap in early recognition and response to anaphylaxis in children < 5 years is misunderstanding the symptoms.
“A lot of people think that an anaphylactic or severe allergic reaction is going to have to involve trouble breathing, and it actually doesn't,” Hoyt said.
In children, anaphylaxis occurs within the first 30 minutes of allergen exposure and presents with symptoms from 2 systems, such as the respiratory, skin, gastrointestinal, or nervous systems. For instance, a 13-month-old child who eats peanut butter and gets itchy hives and vomiting is a sign of anaphylaxis, with 2 systems responding.
An anaphylaxis sign could also be a kid who feels sick after lunch and doesn’t want to play during recess. Their mental health may be affected. The gastrointestinal tract and nervous system are both impacted. Hoyt stresses that anaphylaxis is not always the first symptom, even if it could be the first sign.
“It's really important, and that's one reason I'm part of this collaborative,” Hoyt said. “It’s really important that we provide early childcare professionals with evidence-based up to date information on what anaphylaxis looks like, how to prevent it, how to recognize it, and how to respond to it.”
People can learn more and join the Early Childhood Anaphylaxis Collaborative for free at ECACollaborative.com.
A relevant disclosure for Hoyt includes Genentech, Inc.
References
National Organizations Unite To Prepare Early Childcare Facilities For Rising Incidence Of Food Allergies. Globe Newswire. April 23, 2025. https://www.globenewswire.com/news-release/2025/04/23/3066351/0/en/NATIONAL-ORGANIZATIONS-UNITE-TO-PREPARE-EARLY-CHILDCARE-FACILITIES-FOR-RISING-INCIDENCE-OF-FOOD-ALLERGIES.html. Accessed May 2, 2025.
National Center for Educational Statistics (NCES). 2019. Fast Facts. Accessed Feb. 21, 2025. https://nces.ed.gov/fastfacts/display.asp?id=4.
Santos, Mae Jhelene L., et al. Food Allergy Education and Management in Early Learning and Childcare Centres: A Scoping Review on Current Practices and Gaps. Children 2023;10(7):1175.
Food Allergy Research & Education (FARE). Facts and Statistics. https://www.foodallergy.org/resources/facts-and-statistics#:~:text=Food%20allergy%20prevalence%20among%20children,percent%20between%202007%20and%202021.&text=In%20the%20United%20States%2C%20the,tripled%20between%201997%20and%202008. Accessed May 2, 2025.
Du Toit G, Roberts G, Sayre PH, Bahnson HT, Radulovic S, Santos AF, Brough HA, Phippard D, Basting M, Feeney M, Turcanu V, Sever ML, Gomez Lorenzo M, Plaut M, Lack G; LEAP Study Team. Randomized trial of peanut consumption in infants at risk for peanut allergy. N Engl J Med. 2015 Feb 26;372(9):803-13. doi: 10.1056/NEJMoa1414850. Epub 2015 Feb 23. Erratum in: N Engl J Med. 2016 Jul 28;375(4):398. doi: 10.1056/NEJMx150044. PMID: 25705822; PMCID: PMC4416404.
