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Background Food allergy becomes a public health problem whose prevalence in children is increasing. Due to the daily number of children using school canteens, these settings play an important role on allergic reactions prevention, being essential to know the knowledge level of food handlers. Methods This study focused on Portuguese schools of the city of Porto, that daily offer 6500 lunches to children aged 3 to 10 years old. The study was performed in all school canteens having children with food allergies (n = 25). To evaluate knowledge level on food allergy, a questionnaire was applied to all food handlers responsible for meals serving, considering hot topics related to food allergy and cross contamination practices. Each question was scored: 0 (lack); 1 (correct); -1 (incorrect), ranged 0 to 20 points. The knowledge level was converted in a 4-level scale: &amp;lt;50% (non-acceptable); 50-74% (acceptable); 75-89% (good); 90-100% (very good). Results Despite of 44.9% of food handlers presented a good level knowledge, it was observed that 38.8% of participants showed non-acceptable values. The knowledge mean level was 11.9 (±4.1) points. A high knowledge was observed for cooks (13.8±3.0) and canteen managers (20.0±0.0) (p = 0.006), as well as, for a high school level. Only 36.7% of participants had training on food allergy, with no influence on knowledge level (0.610). Participants having training on food safety has a higher knowledge level (13.0±3.9) than food handlers having no training (9.8±3.7) (p = 0.008). The majority of respondents showed to know food handling good practices when exposed to case studies related to food allergy. Conclusions A positive level of knowledge on food allergies was observed for the majority of food handlers. Nevertheless, a high number of participants had no training on food allergy. This work has a potential impact on children's health, awareness for the need to implement regular training actions and surveillance systems at school canteens. Key messages A large number of food handlers showed non-acceptable knowledge levels and no training on food allergy. Professional category influenced knowledge, being important the motivation and training of all employees.

Food allergy: knowledge level of food handlers at school canteens