Peanut allergy testing in infants provokes parental anxiety, but deep breathing may help

Parents whose children are being evaluated for peanut and other food allergies may be anxious during testing, but deep breathing may help them cope, report a pair of studies published in Annals of Allergy, Asthma & Immunology.

The effects of testing on parents

When infants are tested for peanut allergies, parents feel anxious — and parents of infants who are sensitized to peanuts feel the most anxiety, according to the first study.

“New recommendations for early introduction of peanut have changed the thinking in allergy prevention,” author Abigail Lang, MD, a fellow in the allergy and immunology division at Ann and Robert H. Lurie Children’s Hospital of Chicago and Northwestern University Feinberg School of Medicine, told Healio.

Abigail Lang

“However, there have been differing opinions in consensus statements about whether infants at risk of peanut allergy need to undergo testing for food allergy prior to introducing peanut into their diets,” Lang said.

The study involved 107 infants aged 4 to 11 months (mean age, 7.66 months; 56.6% boys; 49.1% white) with egg allergy and/or moderate to severe atopic dermatitis who were referred to the allergy and immunology division for evaluation in a specialized peanut early introduction clinic. Mothers accompanied infants for 60.4% of visits, whereas both parents were present for 32.1% of visits.

As part of understanding the effects of testing prior to introduction, the researchers assessed whether seeing an allergist prior to introducing peanut at home would impact parental anxiety levels.

The parents of these infants completed the PROMIS-29 validated health-related quality-of-life questionnaire immediately after the clinical visit. The questionnaire asked about physical function, anxiety, depression, fatigue, sleep disturbance, social participation and pain interference.

The median parental PROMIS-29 anxiety t-scores were 40.3 (interquartile range [IQR], 40.3-53.6) for those with infants who were not allergic to peanut (n =53), 52.1 (IQR, 40.3-59.55) for those with infants who were sensitized to peanut (n = 39) and 48.5 (IQR, 40.3-54.1) for those with infants who were allergic to peanut (n = 15).

Also, the parents of infants who were sensitized to peanut had an average anxiety t-score 3.9 points higher than the parents of infants who were not allergic (P = .034) after controlling for which parent completed the PROMIS-29 and which parent or parents were present during the visit.

“We found that parents of infants sensitized to peanut (positive skin test to peanut, but still needs further testing to confirm or rule-out a peanut allergy), but not parents of infants with peanut allergy, had higher anxiety scores as compared to parents of nonallergic infants,” Lang said.

“We think this might be because parents are seeking out a definite answer to whether or not their baby has an allergy,” she continued. “The uncertainty of a positive test with need for further workup might contribute to heightened anxiety.”

Meanwhile, mothers had higher median anxiety t-scores than fathers (48.2 vs. 40.3; P = .023), although no significant differences occurred based on the infant’s biologic sex, age, race, insurance status or referral reason.

The researchers said their findings indicated that the anxiety felt by parents of infants who are sensitized to peanuts may be a potential unintended consequence of peanut allergy screenings.

“Clinicians should be mindful that testing for food allergies prior to introduction might cause increased anxiety, at least in the short-term. Family-centered shared decision-making will continue to be important as we learn more about prevention of food allergies,” Lang said.

“The next step is to reassess parent anxiety after the initial allergist visit to see if the effects on increased anxiety persist or change over time when additional testing, such as oral food challenge, is done for the infants sensitized to peanut,” she said.

Deep breathing’s effect on anxiety

Parents whose children were going through oral food challenges reported that they felt less anxious about the procedure after performing deep breathing exercises, according to the second study.

Chantel E. Canessa, DNP, adjunct professor at University of British Columbia School of Nursing in Vancouver, Canada, and colleagues reported that the stress and anxiety that children feel during medical procedures may be minimized by managing parental anxiety. Although cognitive behavioral therapy may help reduce anxiety among parents of children with food allergies, the researchers continued, it is not always feasible. Diaphragmatic or deep breathing (DB) may reduce anxiety as well, the researchers said.

The researchers recruited 97 parents of children scheduled for an oral food challenge at an outpatient pediatric allergy clinic between April 2018 and April 2019. The cohort included 54 parents who received the DB intervention (median age, 37 years; IQR, 33-41; 94.3% women; 30.8% personal/family history of anxiety) and 38 who served as controls (median age, 38 years; IQR, 34-41; 72.2% women; 29.4% personal/family history of anxiety).

All parents completed the subjective and self-reported Spielberger State Trait Anxiety Inventory-State (STAI-S) test before the OFC was administered and an hour after its completion. Galvanic Skin Response (GSR) tests — which measure electrodermal activity

in response to stress, providing a physiological indicator of anxiety — were administered before the OFC, after the OFC but before the first dose of food, and an hour after the OFC as well.

Next, a research nurse instructed the parents in the DB group in how to use the Belly Breath app, which uses a biofeedback finger sensor to guide slow DB by following an avatar’s breathing pattern and feedback. Parents in the DB group were connected to the GSR device during the guided intervention.

The researchers found no significant difference between the mean pre-OFC STAI-S scores for the DB and control groups. After the OFC, the DB group had significantly lower STAI-S scores (–0.4; P = .041), whereas the control group had a slight increase (0.2).

However, the GSR testing revealed no significant differences between the DB and control groups at any of the three time points, indicating that physiological measures of anxiety did not respond to the intervention, according to the researchers.

Although the researchers called the improvement in parents’ self-reposted anxiety in the DB group statistically significant, it was marginal and not clinically relevant. Still, more than 90% of the DB group endorsed the use of a coping intervention to help anxious parents manage stress before a child’s OFC. Plus, 79.2% said they would use DB to reduce stress in the future.

References:

• Canessa CE, et al. Ann Allergy Asthma Immunol. 2022;doi:10.1016/j.anai.2022.01.029.
• Lang A, et al. Ann Allergy Asthma Immunol. 2022;doi:10.1016/j.anai.2022.01.038.

For more information:

Abigail Lang, MD, can be reached at alang@luriechildrens.org.