Food allergy-related distress may lead to avoidant-restrictive food intake disorder

Diagnosis of avoidant-restrictive food intake disorder may exacerbate the burden of food allergy and complicate assessment and treatment of children with food allergy, according to a study.

The authors of the study, published in The Journal of Allergy and Clinical Immunology: In Practice, wrote that avoidant-restrictive food intake disorder (ARFID) may be more prevalent in the food-allergic population and is considered generally responsive to intensive feeding therapy in young children.

“In some cases, food allergy is further complicated by extreme food aversion and dietary restriction (self- or parent-imposed) that extend beyond medically necessary dietary restrictions and meet criteria for ARFID,” Meera M. Patrawala, MD, from Emory University in Atlanta, Georgia, and colleagues wrote. “These additional maladaptive feeding behaviors add to the child’s overall impairment, may result in nutritional deficiencies, and may foster dysfunctional parental accommodation and diminish family quality of life.”

Patrawala and colleagues examined the co-occurrence and family impacts of ARFID in a case series of patients seen at a tertiary pediatric food allergy clinic to assess psychosocial impairment among children with ARFID and food allergy.

The study comprised 54 children (mean age 7.3 years; 67% male), 48 who participated in an ARFID interview and six who were established patients in the feeding program. Each child classified as meeting criteria for ARFID subtypes A1 to A4. Of the 48 interviewed, parents of 42 children completed a 25-item Feeding Impact Scale (FIS) validated survey, which was scored on a 5-point Likert scale considering feeding impact on family and parent.

The 34 patients who met criteria for one or more ARFID subtype and were classified as having “probable ARFID” tended to have more than two suspected or reported food allergies compared with those in the non-ARFID group. These patients also had a higher feeding impact on family score (35.7 vs. 27.7) and feeding impact on parent score (34.5 vs. 29) compared with the non-ARFID group.

The researchers noted that parents of children with probable ARFID reported greater than expected psychosocial impact for food allergy alone, such as ritualistic or rigid eating behaviors by the family or child that were considered distressing.

Limitations of the study included potential ascertainment bias and missing data, and that it may not be representative of the general food allergy population.

“The findings suggest, however, that additional multidisciplinary research is warranted to define the maladaptive feeding behavioral profiles that exceed the expected level of psychosocial impairment in food allergy and meet the ARFID A4 criterion,” Patrawala and colleagues wrote. “Once developed, these defining behavioral profiles could be used to estimate the prevalence of ARFID manifestations in a broader sample of children with food allergy and continue development and testing of treatment models.”

The researchers added that, in the absence of clinical guidelines, a successful intervention for ARFID is likely to require a multidisciplinary approach to manage its medical and psychosocial effects.