Epinephrine availability and allergen avoidance behaviors among caregivers of young children with food allergy

Background: Parents are primary caregivers for young children with food allergy. Although food allergy‐related caregiver stress is well documented, little is known about caregivers’ daily food allergy management behaviors such as identifying safe foods and epinephrine availability. Objective: This study characterized caregivers’ daily food allergy management behaviors and identified potential areas of food allergy education and intervention. Methods: Eighty-three primary caregivers (91% women) of young children (mean ± standard deviation age 3.16 ± 1.33 years; 37% girls, 65% White), diagnosed with an immunoglobulin E‐mediated food allergy, were recruited from pediatric food allergy clinics. Participants completed two separate food allergy management 24-hour recall‐caregiver interviews. Summary statistics were calculated to characterize overall caregiver food allergy management behaviors with regard to their young children’s snacks and meals. Results: The majority of meals and/or snacks were eaten at home (64.4%) or daycare and/or school (23.4%). Adults observed 99.4% of meals and/or snacks (70.1% by parents). Epinephrine autoinjectors were available for 95.8% of meals and/or snacks, usually in a nearby room (82.1%). Most foods and/or beverages (87.8%) were prepared at home and, for most (98.2%), the caregiver did not take a specific action that day to ensure the food was allergen-free, but some caregivers checked the ingredients on an earlier date (21.3%) or on the general product (30.3%). Conclusion: Analysis of results indicated frequent epinephrine availability but infrequent use of behaviors that verify foods as allergen-free when the food is ingested, which may place children at risk of allergic reactions and indicates a need for clinician education on food safety decision-making. The findings highlight the need for support for primary caregivers, who are preparing the majority of children’s meals and/or snacks, and education and/or policy for daycare and/or schools where many meals are ingested.