ORIGINAL ARTICLE The parent-reported prevalence and management of peanut and nut allergy in school children in the Australian Capital Territory Marjan Kljakovic, 1 Paul Gatenby, 1 Carolyn Hawkins, 1 Robyn G Attewell, 3 Karen Ciszek, 2 Gitta Kratochvil, 1 Alayne Moreira 1 and Anne-Louise Ponsonby 4,5 1 Australian National University Medical School, 2 ACT Community Health, Australian Capital Territory, 3 Biometrics Operations, Covance Pty Ltd, 4 Murdoch Childrens Research Institute, Victoria, 5 Menzies Research Institute, University of Tasmania, Tasmania, Australia Aim: To describe parent-reported prevalence and management of peanut and nut allergy in school entrant children. Method: A population-based, cross-sectional study in the Australian National Capital. Results: Out of 3851 children, parents reported 127 had a strong allergic reaction to peanuts and 19 to other nuts ever. Nut allergy ever prevalence was 3.8% (95% confidence interval 3.2–4.4%), and of peanut allergy ever 3.3% (2.8–3.9%). Children with nut allergy were more likely to have a general practitioner (odds ratio 2.64, 1.16–6.03), hay fever (3.78, 2.67–5.36), eczema (4.54, 3.15–6.56) and wheeze in the last 12 months (3.19, 2.22–4.59) and have been breastfed (2.68, 1.26–5.77) than those who did not. At follow up of 109 children with parent-reported allergy (75% response), 70% had diagnostic test-confirmed sensitisation, 32% had been prescribed an adrenalin autoinjector (6% had used one) and 46% were not eating peanut. Increasing severity of reported symptoms following consumption of peanut was associated with an increasing likelihood of recommended management. Based on parent report, the projected estimated diagnostic test-confirmed prevalence of peanut sensitisation was 2.4% (1.9%, 3.0%) for the entire sample. Conclusion: Among a highly representative sample of children at school entry, 1 in 30 parents reported their child to have a strong allergic reaction to nuts and over 1 in 50 are estimated to have diagnostic test-confirmed peanut sensitisation, based on parent report. Key words: adrenalin autoinjector; allergy; anaphylaxis; general practice; management adherence; nut; peanut. Peanut sensitisation and allergy in childhood appears to be increasing in prevalence. 1,2 Previous studies on nut allergy have been conducted in high-risk groups and population-based data are rare. Understanding how nut allergy is managed is impor- tant because it affects many children in the community, 1 it appears to be a growing problem and there is a real potential for life-threatening anaphylactic reactions. 3 Peanut accounts for two-thirds of all fatal food-induced anaphylaxis. 4 As a result of this, authorities in Australia are under pressure to develop risk management strategies. For example, parental pressure has led to peanut-free schools. Despite this, there has been no research describing the community management strategies for peanut allergy in Australia. The management of allergy and anaphylaxis to peanut is outlined in the Australasian Society of Clinical Immunology and Allergy guidelines 5 where parents are encouraged to take their child to a doctor to confirm a diagnosis of peanut allergy and have an anaphylaxis action plan in place. The aims of this study were to describe the prevalence of reported peanut and other nut allergy in the Australian Capital Territory (ACT), the characteristics of children with reported nut allergy and the association between reported nut allergy and other atopic disease at primary school. Secondly, the follow-up study aimed to assess how parent-reported nut allergy is managed in the community. Method Sample frame All new entrants to primary schools with parent-reported nut allergy were selected from those who took part in the ACT Kindergarten Health Screen in 2005. The Health Screen Ques- tionnaire (HSQ) has been described elsewhere. 6 Parents are asked to report on a variety of health issues in their child and response rates range from 85% to 89%. Data are collected on the child’s demographics and four possible atopic outcomes as Key Points 1 The prevalence of parent-reported peanut allergy in school entry children was 3.3%. 2 There were strong associations between reported peanut and nut allergy with other atopic disease, breastfeeding and having a current general practitioner. 3 Increasing severity of reported symptoms following consump- tion of peanut was associated with an increasing likelihood of recommended management and an action plan. Correspondence: Professor Marjan Kljakovic, Australian National Univer- sity Medical School, PO Box 11 Woden, ACT 2606, Australia. Fax: +61 2 62444105; email: marjan.kljakovic@anu.edu.au Accepted for publication 22 July 2008. doi:10.1111/j.1440-1754.2008.01436.x Journal of Paediatrics and Child Health 45 (2009) 98–103 © 2009 The Authors Journal compilation © 2009 Paediatrics and Child Health Division (Royal Australasian College of Physicians) 98