Review and Feature Article
Psychotherapeutic Treatment for Psychosocial Concerns Related to Food Allergy: Current Treatment Approaches and Unmet Needs

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Psychosocial concerns, such as anxiety and decreased quality of life, are common among patients with food allergy and their caregivers. There is evidence that childhood anxiety disorders are at the outset of a “cascade of psychopathology,” highlighting the importance of early recognition and treatment. Provision of psychological services is needed, beginning with a thorough assessment of food allergy–related quality of life, subjective perceptions of food allergy severity, and environmental factors. Implementation of patient-centered cognitive-behavioral, medical coping, and motivational interviewing strategies may promote healthy food allergy management and adjustment. We present 2 cases, a mother of a young child with food allergy and a young boy preparing for oral immunotherapy treatment, who received psychological services for food allergy–related anxiety. For each, treatment resulted in decreased anxiety and improved food allergy management/oral immunotherapy treatment engagement. We also discuss unmet food allergy–related psychosocial needs, including the lack of food allergy–specific anxiety measures, psychosocial domains that warrant investigation (trauma, feeding concerns), development of supportive interventions for patients engaging in allergen immunotherapy, and the lack of adequate mental health providers with food allergy expertise.

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

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  • 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.

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