Document resource
Background As the prevalence of pediatric food allergy (FA) and food-induced anaphylaxis rises rapidly worldwide, it presents a growing, life-threatening emergency burden. In developing countries like China, where pediatric allergology remains an emerging and highly fragmented specialty, healthcare provider readiness is unclear. We aimed to evaluate FA and anaphylaxis competency among Chinese front-line physicians to identify critical practice gaps and inform targeted educational strategies.Methods A multi-center, cross-sectional survey was conducted across all 31 Chinese provinces (August–December 2025) utilizing stratified quota-based sampling to ensure diverse regional representation. The comprehensive questionnaire assessed core competencies across diagnosis, acute management, and long-term care. Latent class analysis (LCA) categorized 22 clinical indicators into underlying cognitive phenotypes. Subsequently, multivariate Firth’s penalized multinomial logistic regression identified independent predictors of class membership.Results Among 1,012 respondents (41.3% pediatricians; 2.7% dedicated allergists), a mere 21.3% achieved adequate overall knowledge (score ≥ 80%). Critical practical gaps were pervasive; notably, only 5.1% correctly identified standard diagnostic food avoidance durations. LCA revealed five distinct competency phenotypes: 1) Outdated Concepts (26.9%, characterized by a dangerous reluctance to administer first-line intramuscular epinephrine); 2) Emergency-driven (22.1%, proficient in acute resuscitation but lacking foundational allergy management skills); 3) Severe Knowledge Deficit (16.0%, unaware of epinephrine auto-injector basics); 4) Theory-heavy, Practice-hesitant (14.1%, failing high-order clinical application, such as recognizing multi-system anaphylaxis, despite theoretical guideline knowledge); and 5) Comprehensive Competency (20.9%, reference group). Lacking a clinical allergy scope strongly predicted membership in the Outdated Concepts (aOR = 5.71) and Severe Deficit (aOR = 5.73) classes. Primary hospital employment (aOR = 4.49) and lower educational attainment also predicted severe deficits. Notably, no factors predicted the Theory-heavy class, revealing a systemic, universal inability to translate theoretical guidelines into complex clinical practice across all healthcare tiers.Conclusions Nearly 80% of Chinese front-line physicians lack essential FA and anaphylaxis competency. In a developing nation facing a surging epidemiological burden alongside an underdeveloped allergy infrastructure, this profound cognitive dissociation between theoretical knowledge and practical application constitutes a preventable patient safety crisis. These findings demand an urgent, systemic shift away from traditional didactic lectures toward practice-oriented, simulation-based training interventions to safeguard vulnerable pediatric populations.