COVID-19 pandemic creates significant worries among adult patients with food allergy

Key takeaways:

• Adults with food allergy reported significant increases in worry pertaining to accidental allergen exposure, experiencing severe symptoms upon accidental ingestion, fatalities related to food allergy and perceived inabilities to identify and treat anaphylaxis.
• Younger female respondents reported greater psychosocial burdens than older male respondents.
• Only 9.7% of respondents reported changes in their anaphylaxis management due to COVID-19.

The COVID-19 pandemic and traumatic events associated with it adversely affected the mental health and well-being of adults with food allergy, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

These findings may help inform public health efforts, Christopher Warren, PhD, director of population health research at the Center for Food Allergy & Asthma Research, Northwestern University Feinberg School of Medicine, and colleagues wrote in the study.

The researchers developed and administered a survey to patients recruited through Food Allergy Research and Education (n = 351) between May 20 and June 15, 2020, and the Sean N. Parker Center for Allergy and Asthma Research at Stanford University (n = 154) between June 1, 2020, and April 16, 2021.

The cohort was 77.3% women and 83.4% white. Ages of the cohort included 36.3% aged 18 to 30 years, 37.3% aged 31 to 50 years and 26.4% aged older than 50 years. The population included 57 respondents (11.3%) who lived below the 2020 federal poverty line as well.

Also, 13.9% had seen a mental health professional about their food allergy, and 31.1% had been diagnosed with an anxiety disorder.

The survey included four questions about expectations of adverse outcomes, food allergy-related psychosocial burdens, food-related behavior and health care utilization, all compared with the respondents’ perceived levels of each construct in 2019. The scale ranged from 0 (much less now) to 10 (much more now), with 5 representing “no change.”

The researchers reported significant (P < .05) increases in worry involving accidental allergen exposure, experiencing severe symptoms upon accidental ingestion, food allergy-related fatality and perceived inability to successfully identify and treat food-induced anaphylaxis.

Also, the respondents indicated greater stress, anxiety and worry about food allergy in general (P < .001) during the pandemic compared with before the pandemic.

The survey additionally found greater worry (P < .001) among respondents about their ability to eat a diverse and nutritious diet, obtain safe and allergen-free foods or ingredients and avoid cross-contact when purchasing prepared or delivered foods.

The greatest reported increases in worry involved calling 911, potentially receiving food allergy treatment in the ED and going to the ED for food allergy treatment.

Compared with older male participants, younger female respondents reported greater psychosocial burdens, especially in terms of general worry, anxiety and stress related to food allergies and concerns about cross-contact and obtaining allergen-free foods.

Allergen cross-contact in purchasing prepared or delivered foods, ability to eat a diverse and nutritious diet and ability to obtain safe and allergen-free foods were the greatest worries among respondents below the federal poverty line and those reporting decreased family income, in addition to greater worry, anxiety and stress about food allergy in general.

Households with lower socioeconomic status were more likely to report difficulties in obtaining food, medicine and necessary health care as well.

Additionally, the researchers found significantly higher mean COVID-19 Exposure and Family Impact Scale (CEFIS) scores among respondents with asthma and among those below the 2020 poverty line.

Expectations of adverse food allergy outcomes increased as the impacts of COVID-19 increased (B, 0.05-0.13; standard error (SE), 0.03-0.04), as did stress, anxiety and worry related to food allergy (B, 0.07-0.09; SE, 0.04).

The researchers also found greater worry about potentially receiving food allergy care in the ED (B, 0.1; SE, 0.04) and calling 911 after experiencing food allergy symptoms (B, 0.07; SE, 0.04) among patients with higher CEFIS scores.

The researchers expressed particular concern about these findings, considering the importance of rapid identification and treatment of anaphylaxis as well as the low rates of epinephrine carriage among the general population of adults with food allergies.

Also, due to the pandemic, recommendations for anaphylaxis treatment were changed to purposeful and watchful waiting to see if epinephrine had any effect on the reaction before administering a second dose if needed and then activating EMS if symptoms do not resolve. These changes were made to alleviate burden on EMS and hospitals.

The survey revealed that 66.2% of these patients had a food allergy emergency care plan that recommended emergency autoinjector use, although only 9.7% reported changes in their plan due to COVID-19, indicating a lack of broad and prompt implementation of recommendations to modify anaphylaxis management plans during the pandemic.

Based on these findings, the researchers said that some adults with food allergies may not have had follow-up care with a health care provider who would have been able to inform them of these new recommendations.

Overall, the researchers concluded that these findings in how adults with food allergy perceive the changes in their care and in the food environment as well as in their psychosocial burdens may help inform current and future public health efforts.