Safer Food Allergy Management for Adolescents

Among the 15 million people with food allergies in the United States, adolescents experience
the highest risk of adverse events, including death from anaphylaxis. Visits to one pediatric
emergency department for anaphylaxis doubled between 2001 and 2006, suggesting a rapidly
escalating public health burden. Despite this critical concern, there are few evidence-based
strategies to improve food allergy management in adolescents, who must sustain three core
prevention strategies: diligent avoidance of allergenic foods, consistent carrying of
potentially life-saving epinephrine auto-injectors, and prompt administration of epinephrine
in the event of anaphylaxis.

The objective of this study is to develop and test interventions to encourage safer food
allergy management among adolescents. The primary outcome is consistency of
epinephrine-carrying, measured using cell phone photographs at randomly-timed check-ins. This
study will be among the first to longitudinally track normative food allergy management
practices and one of the first to test behavior change strategies.

In a cohort multiple randomized controlled trial (n=130), the study will include two
experiments to test the effectiveness of text message reminders and incentives, using various
incentive designs that have proven effective in prior behavioral economics interventions to
encourage weight loss and smoking cessation. Aim 1. Test the impact of a text-message
reminder system on consistency of epinephrine carrying. Aim 2. Test the impact of modest
incentives on consistency of epinephrine carrying. Based on promising preliminary data, the
central hypothesis is that, compared to controls, adolescents who receive text message
reminders plus modest financial incentives will more consistently carry their epinephrine.

Inclusion Criteria:

- Food allergy diagnosis by a physician and recorded in the medical chart

- Prior prescription of epinephrine auto-injector to treat anaphylaxis

- Access to a cell phone capable of sending and receiving text messages and photographs
(our team will provide cell phones to participants willing to participate, but who do
not own a cellphone)

- Fluent in English

- Between ages 15-19 at baseline

Exclusion Criteria:

- Unable to obtain permission (consent) of a parent to participate in the study

- Will not or cannot give assent

- Currently participating in another clinical trial with related aims