The Journal of Allergy and Clinical Immunology: In Practice
Review and Feature ArticlePsychotherapeutic Treatment for Psychosocial Concerns Related to Food Allergy: Current Treatment Approaches and Unmet Needs
Section snippets
Background
Many children are diagnosed with FA during early childhood, so caregivers bear the brunt of FA management.9 Allergen avoidance and emergency management requires caregivers to have the behavioral skills to manage allergen avoidance and allergic reactions. They must also have the emotional resources to cope with the many challenges that arise from these daily tasks and the social limitations that FA presents. Many patients with FA and their caregivers experience decreased FAQL related to these
Assessment of Food Allergy–Related Psychosocial Functioning
FAQL should be of paramount importance when making treatment decisions because currently there is no reliable way to stratify risk for anaphylaxis and data regarding specific interventions to reduce said risk is sparse.22 In FA, the risk is ever present but the “when,” “what,” “why,” and “how much” lead to uncertainty, fear, and anxiety. Research on FAQL, using Food Allergy Quality of Life Questionnaires (FAQLQ), has provided a patient-centered perspective and innovative findings with
Psychotherapeutic Intervention Approaches
The extant literature regarding evidence-based psychotherapeutic interventions for FA is sparse. Existing behavioral interventions target caregivers,27,38 are limited to a one-time group/activity,39,40 and/or focus on one challenging aspect of FA rather than comprehensive FA education and skill building.41, 42, 43 In a recent systematic review of interventions that targeted well-being and support for caregivers of children with FA, the authors concluded that cognitive-behavioral strategies may
Case 1: TF, The Mother of a 2-Year-Old Girl
Mothers of children with FA frequently present with anxiety about FA management and treatment of allergic reactions. This case provides an overview of how brief cognitive-behavioral therapy can improve maternal FA self-efficacy and FAQL.
Case 2: JD, A 7-Year-Old Boy
Although adolescents and young adults are the more usual focus for support in self-management of FA, it is also important for young children to be active participants in management. Early onset anxiety disorders (<13 years of age), as in this case study, have a tendency to follow a chronic course. It is important to recognize “red flags” and to refer if appropriate. Screening and measurement tools, such as the examples given here, can be helpful in this regard. Even parents/patients who do not
Case Summaries
The 2 case examples show that there are specific times when patients and their parents may benefit from more than standard allergy education and a sympathetic allergist's ear, such as when families need psychoeducation, assistance coping with FA anxiety, assistance problem-solving new treatments, and/or when they meet criteria for a mental health disorder.28 As shown in case 1, allergists can use the frequency and intensity of anxiety and the presence of avoidance behaviors as methods of
Discussion and Unmet Needs
Pediatric psychologists are increasingly involved as key members of interdisciplinary research and clinical care teams.52 Psychological issues are addressed in a developmental framework and emphasize the dynamic relationships that exist between children, their families, and the health delivery system as a whole.53 The inclusion of psychologists as key members of interdisciplinary collaborations is not only beneficial for patients and families but also for other health care professionals.
Conclusion
There is evidence that childhood anxiety disorders are at the outset of a “cascade of psychopathology”; therefore, there is a need for early recognition and treatment. In addition to adverse long-term psychopathological outcomes, it also causes impairment in functioning and hampers general health, resulting in financial, interpersonal, and educational difficulties. Pediatric psychologists have a key role in health services for allergic disease that can provide measurable benefits for patients
References (79)
- et al.
Neuroscience-informed psychoeducation for addiction medicine: a neurocognitive perspective
Prog Brain Res
(2017) - et al.
Temporal trends and racial/ethnic disparity in self-reported pediatric food allergy in the United States
Ann Allergy Asthma Immunol
(2014) - et al.
Current and future treatment of peanut allergy
J Allergy Clin Immunol Pract
(2019) - et al.
Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management
J Allergy Clin Immunol
(2018) - et al.
Parents experiences raising a child with food allergy: a qualitative review
J Pediatr Nurs
(2019) - et al.
Food allergy knowledge, attitudes, and beliefs in the United States
Ann Allergy Asthma Immunol
(2009) - et al.
Food allergy knowledge and attitudes of restaurant managers and staff: an EHS-Net study
J Food Prot
(2016) - et al.
Development of a questionnaire to measure quality of life in families with a child with food allergy
J Allergy Clin Immunol
(2004) - et al.
Clinical management of psychosocial concerns related to food allergy
J Allergy Clin Immunol Pract
(2016) - et al.
An examination of the Food Allergy Quality of Life Questionnaire performance in a countrywide American sample of children: cross-cultural differences in age and impact in the United States and Europe
J Allergy Clin Immunol Pract
(2017)
Preliminary development of the Food Allergy Coping and Emotions Questionnaires for children, adolescents, and young people: qualitative analysis of data on IgE-mediated food allergy from five countries
J Allergy Clin Immunol Pract
Food allergen labeling and purchasing habits in the United States and Canada
J Allergy Clin Immunol Pract
A self-regulation intervention can improve quality of life for families with food allergy
J Allergy Clin Immunol
Evaluation of a group intervention for children with food allergy and their parents
Ann Allergy Asthma Immunol
Food-allergic adolescents at risk for anaphylaxis: a randomized controlled study of supervised injection to improve comfort with epinephrine self-injection
J Allergy Clin Immunol Pract
A randomized controlled trial to reduce food allergy anxiety about casual exposure by holding the allergen: TOUCH study
J Allergy Clin Immunol Pract
A behavioral economics intervention to encourage epinephrine-carrying among food-allergic adults: a randomized controlled trial
Ann Allergy Asthma Immunol
Goals and motivations of families pursuing oral immunotherapy for food allergy
J Allergy Clin Immunol Pract
Impact of supervised epinephrine autoinjector administration during food challenges on parent confidence
Ann Allergy Asthma Immunol
Anxiety and anxiety disorders in children and adolescents: developmental issues and implications for DSM-V
Psychiatr Clin North Am
Coping and posttraumatic stress symptoms in children with food allergies
Ann Allergy Asthma Immunol
Trauma exposure characteristics, past traumatic life events, coping strategies, posttraumatic stress disorder, and psychiatric comorbidity among people with anaphylactic shock experience
Comp Psychiatr
Mealtime behavior among parents and their young children with food allergy
Ann Allergy Asthma Immunol
Changing patient mindsets about non-life-threatening symptoms during oral immunotherapy: a randomized clinical trial
J Allergy Clin Immunol Pract
Availability of mental health services for patients with food allergy
J Allergy Clin Immunol Pract
Cognitive Behavior Therapy: Basics and Beyond
The public health impact of parent-reported childhood food allergies in the United States
Pediatrics
Anaphylaxis: past, present and future
Allergy
AR101 oral immunotherapy for peanut allergy
N Engl J Med
Impact of peanut allergy on quality of life, stress and anxiety in the family
Allergy
Anxiety and food allergy: a review of the last two decades
Clin Exp Allergy
Management of nut allergy influences quality of life and anxiety in children and their mothers
Pediatr Allergy Immunol
A systematic review and meta-regression of the knowledge, practices, and training of restaurant and food service personnel toward food allergies and Celiac disease
PLoS One
Food allergy quality of life questionnaire for children aged 0-12 years: content, construct, and cross-cultural validity
Clin Exp Allergy
Incidence of fatal food anaphylaxis in people with food allergy: a systematic review and meta-analysis
Clin Exp Allergy
Current tools measuring anxiety in parents of food-allergic children are inadequate
Pediatr Allergy Immunol
The psychological impact of oral immunotherapy for children with food allergy: perceived benefits and treatment burden
Clin Pract Pediatr Psychol
Maternal intolerance of uncertainty, anxiety, and adherence with food challenge referrals
J Health Psychol
Cited by (0)
No funding was received for this work.
Conflicts of interest: L. Herbert declares no relevant conflicts of interest. A. DunnGalvin is a consultant for Aimmune Therapeutics and DBV Technologies.
- ∗
Co–first authors.