Preliminary data were collected from 80 food allergic families (mean age was 9.5 years) and 5 allergists from community and academic centers in 4 cities. Sixty-one percent of patients were shown how to use an auto injector with a trainer and 51% were asked to demonstrate its use. Fifty five percent of patients did not feel very confident about when to give an auto-injector, or how to administer it correctly (60%) even though on average, it was their third visit with the allergist. Top reasons for not feeling very confident include not using an auto injector in a real situation (71%) and not feeling clear on indication of use (36%). The majority of patients wanted more information on prevention and cure of food allergy (29%), advancements in research (21%), and how to avoid allergens (17%). Allergists' priorities were to make an accurate diagnosis, and teach allergen avoidance and management of acute reactions. All allergists indicated a major challenge was to ensure correct technique and overcome reluctance to use auto injectors. Allergists found it helpful to provide frequent practice with trainers, provide written material and connect patients with support groups. Allergists indicated that anaphylaxis management needs to be incorporated into first aid courses and teacher/daycare provider training. In conclusion caregivers of food allergic patients lack confidence in acute management of reactions, which allergists recognize but find challenging to improve. More frequent demonstrations of auto injector use during clinic visits are needed. Furthermore, training that better stimulates real anaphylaxis reactions, including acute management, needs to be developed.