Q&A: Worries about food allergies increase during the COVID-19 pandemic

Key takeaways:

• During the first year of the COVID-19 pandemic, patients with food allergies worried about accidental allergen exposure, the possibility of severe symptoms and the ability of others in treating potential anaphylaxis.
• Only 9.7% of the survey’s respondents changed how they managed anaphylaxis even though official guidelines changed in response to the pandemic.
• Allergists should refer patients who are experiencing anxiety for mental health counseling.

The COVID-19 pandemic provoked anxiety across the nation for many reasons, but patients with food allergies faced increases in very specific fears, according to a study in The Journal of Allergy and Clinical Immunology: In Practice.

As the lockdown changed how people purchased, prepared and ate their food, the survey of 505 respondents found that patients grew more afraid of accidental allergen exposure and the potential for severe symptoms after accidental ingestion.

These patients also felt worry over potential fatalities related to their food allergies in addition to the inadequacies they saw in the health care system’s ability to identify and treat anaphylaxis.

In fact, 13.9% of respondents had seen a mental health professional about their food allergy, and younger female respondents in the survey reported greater psychosocial burdens than older male respondents.

But despite these increased fears, the authors noted, only 9.7% of the survey’s respondents changed the way they managed anaphylaxis due to COVID-19, even as guidelines changed in response to the pandemic.

Healio spoke with author Christopher Warren, PhD, director of population health research at the Center for Food Allergy & Asthma Research, Northwestern University Feinberg School of Medicine, to find out more.

Healio: What prompted the study?

Warren: As soon as the COVID-19 pandemic began, and especially once shelter-in-place orders were issued in many parts of the country — with the corresponding cancellation of nonurgent allergist visits and/or shift to telemedicine — it was unclear what the effect would be on patients with food allergy, many of whom likely saw disruptions to their typical allergen-free food purchasing routines due to the corresponding supply chain issues.

Christopher Warren

However, on the other hand, with fewer in-person activities, it was also plausible that many patients would find their day-to-day food allergy management facilitated by their more constrained environment, with fewer opportunities for accidental allergen ingestion during social and other functions outside of the home.

So, we conducted the study because we wanted to try to get a better idea of how patients with food allergy were navigating this challenging time and identify the best ways to support them.

Healio: Were there any particularly surprising or significant results?

Warren: One striking finding, given the fact that our sample was recruited through two large food allergy patient registries, who arguably have access to more resources than the average patient, was that very few respondents reported having implemented any changes to their anaphylaxis management plans intended to avoid potential exposure to COVID-19 and unnecessary utilization of hospital resources, despite clear recommendations by major national allergy organizations.

This highlights the ongoing need to be strategic and thoughtful in taking concrete steps to ensure that guidelines and expert recommendations are actually implemented at the clinic, provider and patient levels.

Healio: As restrictions have eased, has there been any change in patient anxieties?

Warren: This is difficult to ascertain via the present study data, given that they were collected between spring 2020 and spring 2021, before most of the adult population yet had access to effective vaccines.

However, it is likely that patient concern and particularly high levels of self-reported anxiety regarding potential COVID-19 exposure in the ED setting and acute concerns about inability to access allergen-free foods owing to supply chain disruption have attenuated somewhat.

Healio: How can doctors help patients who are still coping with these anxieties?

Warren: Data from other studies that our Center for Food Allergy & Asthma Research is involved with suggest that remarkably few patients with food allergy receive referrals for mental health counseling relating to food allergy management, despite the fact that such care has been shown to be highly beneficial. It is recommended that doctors screen for elevated anxiety related to food allergy management and refer to qualified specialists who can help patients. There are also excellent resources that are publicly available from major food allergy organizations, such as Food Allergy Research and Education and Allergy and Asthma Foundation of America. Finally, physicians should familiarize themselves with local food allergy support groups, which are active in-person in many parts or the country as well as online.

Healio: What is the next step in this research?

Warren: The next step in this research involves further analysis of a much larger longitudinal pediatric sample of children with food allergies (and their parents/caregivers) recruited from around the country who have also been surveyed over the past 2 years using a comparable survey measure. Stay tuned!

Reference:

Warren C, et al. J Allergy Clin Immunol Pract. 2022;doi:10.1016/j.jaip.2022.07.036.

For more information:

Christopher Warren, PhD, can be reached at christopher.warren@northwestern.edu.