Psychological support may maximize efficacy of oral immunotherapy for food allergy

Clinicians should evaluate the psychological needs of patients undergoing OIT for food allergy and recommend support when it is warranted, according to a study published in Clinical and Translational Allergy.

OIT can be a challenging process that may last from several months to years and requires daily consumption of food the patients were taught to avoid and fear, according to the researchers.

“Moreover, adverse reactions are often experienced during treatment,” the researchers wrote. “Those range from mild reactions to anaphylaxis. It is understandable that OIT can be a source of anxiety for patients and their families: in particular the induction phase — during which patients are exposed to increasing amounts of food allergen until an allergic reaction develops, to establish the maximal tolerated dose has the potential to create anxiety in OIT participants.”

The anxiety from this, in turn, may affect patients’ motivation to continue therapy.

To investigate the psychological needs and support offered to patients and their families undergoing OIT, the researchers designed an observational, retrospective study that included 50 patients (mean age, 18.02 years; 66% female; 100% white) who undertook psychological treatment for difficulties related to therapy. These patients represented 18% of the total of patients who pursued OIT between October 2013 and October 2019.

Of these patients, 66% sought psychological care spontaneously and 34% did so following an allergist’s suggestion.

During OIT, 66% of patients asked for psychological support for the initial phase, 20% during the up-dosing phase, 8% during maintenance and 6% after discontinuation due to reactions.

Patients mostly asked for psychological support due to emotional problems (70%) including dysfunctional anxiety, distress and mood disorders, and excessive worry or fear related to OIT. Additionally, 20% of treatments were held because of difficulties in managing OIT that included inadequate compliance or maladaptive coping strategies.

Treatments included psychological support such as talk therapy or brief cognitive behavioral therapy (52%), counseling and psychoeducation (38%) and psychotherapy (10%).

All patients reported a bit (60%) or much (40%) improvement after these interventions.

The researchers advised that health care providers should be aware of the psychological challenges these patients and families face and know when to encourage them to seek psychological support.

“This paper could help clinicians to recognize psychological needs and benefits of psychological support in food OIT in order to maximize the efforts and effectiveness of this treatment,” the researchers wrote. “It is recommended to consider the psychological needs in profiling patients and families suitable to OIT and offer specific psychological support when needed.”