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.