Parental anxieties concerning children’s food allergies lessened during COVID-19 shutdown

Most parents saw decreases or no changes in their levels of anxiety related to their children’s food allergies during the COVID-19 lockdown in the spring of 2020, according to a study published in Annals of Allergy, Asthma & Immunology.

However, the available measures for general anxiety and self-reporting anxiety related to the pandemic failed to capture the dimensions of food allergy anxiety (FAA), Clara Westwell-Roper, MD, PhD, a psychiatry research track resident at University of British Columbia, and colleagues wrote.

The researchers conducted a cross-sectional online survey of 293 parents of children with food allergy in May and June 2020. During this period, in-person visits for nonurgent medical care were limited, and most schools were using a virtual model.

The study population

The mean age of the respondents was 43.3 ± 7 years (range, 27-64), while their children had a mean age of 10.4 ± 5.6 years and an average of 8.3 ± 5.3 years from diagnosis. Also, 92% of respondents were mothers, with 79% ± 18% reporting a greater share of managing their child’s food allergy, compared with 58% ± 23% of fathers reporting more responsibility (P < .0005).

Also, 85% of respondents had one child with a food allergy, and 14% had two. Plus, 79% reported that their child’s allergy was severe, 70% reported a history of anaphylaxis and 36% reported a history of asthma.

Reported food allergies included peanuts (80%), tree nuts (56%), eggs (34%), milk (27%), sesame (20%), soy (10%), shellfish (9%), fish (8%), wheat (7%), mustard (2%) and other (21%), with 32% reporting allergy to one or two foods, 31% allergic to three to six foods, 10% allergic to seven to nine foods and 28% allergic to 10 or more.

According to the survey, 49% said only essential services and businesses were operating, and 79% said schools were closed or only operating virtually.

The levels of anxiety

The researchers said that FAA involves emotional, cognitive, behavioral and physical domains. While it is associated with generalized anxiety, where worries about events or activities are difficult to control, the researchers continued, FAA is a distinct construct.

According to the survey, 67% of respondents felt an increase in overall stress and anxiety that they attributed to COVID-19; this included 35% who experienced no changes in their FAA and 24% who saw their FAA decrease.

Only 28% of respondents said they felt an increase in FAA due to the pandemic, whereas 30% said their FAA was unchanged and 42% said that their FAA decreased.

Factors that predict increases in FAA caused by COVID-19 included increased overall anxiety (OR = 3.29; 95% CI, 2.46-4.41), non-nut allergies (OR = 2.86; 95% CI, 1.4-5.5), prior ED visits (OR = 2.5; 95% CI, 1.23-5.09) and avoiding more than two foods due to food allergy (OR = 1.44; 95% CI, 1.14-1.81).

The survey included the 28-item Impairment Measure for Parental food Allergy-related Anxiety and Coping Tool (IMPAACT), which indicated decreases in all dimensions of FAA during the pandemic, especially in worries about unfamiliar places and how other caregivers would manage allergic reactions. Qualitative responses included:

“Primarily, with our immediate family self-isolating, I have felt the day-to-day stress of allergy management lessen, as I have full control over what my son is ingesting.”

“Food allergy anxiety is worse when my child leaves my care. Right now he is always in my care making that anxiety much less.”

The only area where parents reported increases in FAA involved worry about finding “safe” foods at the grocery store:

“The most difficult part is when all my son’s ‘safe foods’ are out of stock. It isn’t easy to just grab whatever is left on the shelves, as they usually have a ‘may contain’ label.”

“We can’t get certain foods we usually get because we are using a delivery service.”

When measuring generalized anxiety symptoms, the researchers also found total GAD-7 scores increase from 5.4 ± 4.9 before the pandemic to 6.2 ± 5.7 during the shutdown (standardized mean difference, 0.15; P = .011), although the researchers said this increase in anxiety-related symptoms was less than the reported minimally clinically important difference of 4.

However, the researchers found that IMPAACT scores substantially decreased from 105 ± 35 before the pandemic to 89 ± 37 during the shutdown (standardized mean difference, 0.44; P < .0005).

With decreased worry about control over exposures and risks for allergic reactions, the researchers wrote, the pandemic may have had unique impacts on the emotional distress of families with children who have chronic health conditions. Further studies should evaluate methods for identifying families who need additional support, they added.