*3.3. In-School Emergency Preparedness*

Food allergy-related emergency preparedness, with regard to self-efficacy, confidence, and food allergy-related emotions, was discussed in 6/12 (50.0%) of studies, all of which were European [37,38,41–44].

Self-efficacy in managing food allergies in school was discussed in three studies, all of which made use of the School Personnel's Self-Efficacy in Managing Food Allergy and Anaphylaxis (SPSMFAA) questionnaire by Polloni et al. (2016) [32] to measure self-efficacy on food allergy management. The questionnaire measures a total of 40 points based on eight factors (1 = cannot do, 5 = highly certain can do) [32]. Compared to anaphylaxis management, food allergy management was associated with greater self-efficacy [38,41,44]. Turkish primary school teachers exhibited that previous food allergy experience and food allergy training were associated with greater self-efficacy in managing a food allergy and anaphylaxis (*p* < 0.001) [38]. In fact, significant SPSMFAA score differences were seen among Turkish primary school teachers with previous food allergy training compared to those who did not have previous training (mean = 26.74/40 ± 6.21, vs. 22.18/40 ± 7.48, respectively; *p* < 0.001) [38].

Confidence in managing anaphylaxis was reported by approximately half (47.3%; 53/112) of UK primary schools, with no difference (*p* = 0.10) among schools with or without students with a food allergy (52.6% vs. 36.1%, respectively) [37]. Most UK schools (60.7%) demonstrated being prepared for allergic reactions in students without a previous allergic history by establishing communication and documentation systems, and identifying staff member roles in the event of an allergic emergency, with no significant difference between schools with vs. without students with food allergy enrolled (61.0% vs. 60.0%, respectively; *p* = 0.94) [37].

Elsewhere, Italian teachers and principals of various grades reported food allergyrelated emotions were concern (66.9%), anxiety (15.8%), fear (3.7%), and helplessness (7.0%). Positive attitudes were also associated (9.3%) in relation to newfound post-intervention knowledge [43].

Three focus groups of Italian primary school teachers (*n* = 25) qualitatively discussed concerns over managing the child in crisis and other students in class [42]. Teachers were unauthorized to administer certain (unspecified) drugs, thus, had restricted emergency management abilities to providing first aid and calling for help. It was not disclosed what type of first aid treatment teachers were allowed to perform. Feelings of insecurity were described, and teachers felt unable to manage emergencies due to the perceived lack of food allergy knowledge. Additionally, teachers thought that the responsibility of food allergy management was beyond their teaching duties and required more emotional involvement [42].
