Background: Initial food‐allergic reactions are often poorly recognized and under‐treated. Methods: Parents of food‐allergic children were invited to complete an online questionnaire, designed with Kids with Food Allergies Foundation , about their children’s first food‐allergic reactions resulting in urgent medical evaluation. Results: Among 1361 reactions, 76% (95% CI 74–79%) were highly likely to represent anaphylaxis based on NIAID/FAAN criteria. Only 34% (95% CI 31–37%) of these were administered epinephrine. In 56% of these, epinephrine was administered by emergency departments; 20% by parents; 9% by paramedics; 8% by primary care physicians; and 6% by urgent care centers. In 26% of these, epinephrine was given within 15 min of the onset of symptoms; 54% within 30 min; 82% within 1 h; and 93% within 2 h. Factors associated with a decreased likelihood of receiving epinephrine for anaphylaxis included age <12 months, milk and egg triggers, and symptoms of abdominal pain and/or diarrhea. Epinephrine was more likely to be given to asthmatic children and children with peanut or tree nut ingestion prior to event. Post‐treatment, 42% of reactions likely to represent anaphylaxis were referred to allergists, 34% prescribed and/or given epinephrine auto‐injectors, 17% trained to use epinephrine auto‐injectors, and 19% given emergency action plans. Of patients treated with epinephrine, only half (47%) were prescribed epinephrine auto‐injectors. Conclusions: Only one‐third of initial food‐allergic reactions with symptoms of anaphylaxis were recognized and treated with epinephrine. Fewer than half of patients were referred to allergists. There is still a need to increase education and awareness about food‐induced anaphylaxis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93515/1/pai1315.pd
