*3.2. Baseline Knowledge*

Teachers and school staff reported poor knowledge of food allergy understanding and anaphylaxis management at baseline in 6/12 (50.0%) studies from Italy, Spain, USA, and Turkey [34,38–40,42,43]. Turkish and Italian teachers and school staff had knowledge of allergic reaction symptoms, but a poor understanding of food allergy and anaphylaxis management [39,42,43]. Notably, Italian teachers and principals from primary schools had statistically significant higher baseline questionnaire scores than middle schools (*p* < 0.001) when compared through one way analysis of variance and Bonferroni post hoc test [43].

The majority of American primary school teachers from economically-advantaged and disadvantaged areas (78.3% and 76.5%, respectively) [34] and one group of Italian teachers and school staff of various grade levels (79.3%) were able to identify common allergenic foods [43], compared to approximately 40.0% of Turkish primary school teachers, and another group of Italian primary school teachers, who correctly answered questions about food as allergic triggers [39,42]. Interestingly, one group of primary school Italian teachers acknowledged having poor food allergy knowledge (mean = 5.1/10; Standard Deviation (SD) = 2.1) but perceived food allergy as a significant issue in schools (mean = 7.6/10, SD = 2.1, based on a scale of 1–10, with higher scores corresponding to higher significance) [42].

The economic advantage of school areas appeared to also influence teacher and school staff's baseline food allergy knowledge. Primary school teachers in both Houston, USA, and Turkey from schools in economically-advantaged areas had more non-statistically significant higher baseline food allergy knowledge than teachers from economicallydisadvantaged areas [34,39].

Anaphylaxis knowledge was likewise poor as reported in 3/12 (25.0%) of studies from Italy, Spain, and the USA [34,40,43]. Italian and Spanish authors determined that teachers' and school staff's baseline knowledge was not influenced by previous education on food allergy or experience working with students with an anaphylaxis history [40,43].

An estimated 45.3% of Spanish primary school teachers [40] and 65.4% of Italian [43] teachers of various grade levels correctly reported that epinephrine is the main anaphylaxis treatment. Similar rates of anaphylaxis treatment knowledge were reported by American teachers from economically-disadvantaged areas (45.3–49.0%) compared to teachers from economically-advantaged areas (70.0–80.6%) [34]. Conversely, fewer Italian teachers and principals of various grade levels (34.5%) knew epinephrine was safe to use for suspected anaphylaxis without severe side effects [43]. Fewer Spanish and Turkish primary school teachers and canteen staff knew what an EAI was (10.1% [39], and 18.9% [40], respectively), or how to use an EAI (6.8–13.2%) [39,40] and where to administer it (3.8%) [39]. If faced with a food allergy-related emergency, only 24.5% of Turkish primary school teachers stated they would administer first aid, although none of the teachers identified that epinephrine was the appropriate medication to use [39].
