Knowledge, attitudes, and practices toward food allergies among early childhood educators in Taiwan: a cross-sectional study

Abstract Background The prevalence of food allergies among Taiwanese children has risen to 10.4%, which is notably higher than that in many other Asian regions. However, despite this trend, Taiwan lacks specialized legislation or standardized national protocols for the management of food allergies in school settings. In this study, we assessed the knowledge, attitudes, and practices of kindergarten staff to identify key management gaps and unmet institutional needs. Methods A cross-sectional, questionnaire-based study was conducted among 208 kindergarten staff members throughout Taiwan. Participants were categorized into major metropolitan areas (MMAs) and general urban-rural areas (GURAs) to evaluate regional disparities in resources and proficiency. Results Although 88.0% of staff were aware of students with food allergies, there was a notable deficiency in clinical literacy. Only 13.5% recognized gluten as a trigger for severe reactions, and 82.2% were unaware of food-dependent exercise-induced anaphylaxis. Moreover, emergency preparedness was exceptionally low, with 74.0% of schools lacking formal response plans, 84.6% of staff unfamiliar with epinephrine autoinjectors, and only 2.9% of schools maintaining stocks of emergency medication. In addition, 53.4% of staff reported a refusal to administer life-saving medication due to legal anxiety. Although staff in MMAs reported higher clinical vigilance, experience, and a proactive willingness to perform on-site injections, a “uniform lack of competence” regarding emergency resources in both assessed regions. However, 83.6% of respondents expressed a strong willingness to pursue further training. Conclusions The findings of this study reveal a systemic national failure in the food allergy safety policies of schools, rather than regional socioeconomic disparities. The discrepancy between high staff motivation and low clinical proficiency highlights the urgent need for mandatory, standardized professional development and hands-on emergency drills to ensure a safe educational environment.