Q&A: Peanut bullying incident reveals opportunities for food allergy education, engagement

Key takeaways:

• Two high school football players allegedly spread peanut products on the uniform and cleats of a teammate with a peanut allergy.
• Between 19% and 60% of youth with food allergy experience bullying.

Two football players at Lake Travis High School in Lake Travis, Texas, have been accused of coating the cleats and uniform of a teammate with a severe peanut allergy in peanut products. The teammate developed hives.

Local news reported that these students were aware of their teammate’s allergy and recorded the incident. The school district has said that these students have faced consequences for their actions, but privacy policies prevent the district from further comment.

Bullying incidents involving food allergy are common and could have potentially dangerous impacts on physical and mental health, Melissa Engel, MA, clinical psychology doctoral candidate at Emory University, told Healio. We spoke with her to find out more.

Healio: Generally, how common is teasing and bullying among children with food allergy?

Engel: Teasing and bullying are common among children and adolescents with food allergy. Research suggests that 19% to 60% of youth with food allergy experience bullying. Estimates vary based on the sample, measures and reporter, yet many studies find a prevalence of about one in three. Although more research is certainly needed in this area, recent work has highlighted discrepancies between caregiver and youth reports of bullying, emphasizing the importance of obtaining multiple perspectives. Additionally, rates of bullying among youth with food allergy tend to be higher when bullying is assessed with multi-item rather than single-item measures.

In my experiences in leading peer programs for children and adolescents with food allergy through Food Allergy Research & Education (FARE), I have found that perceptions of bullying vary greatly depending on how a question is asked. For instance, when I frame a question about bullying in general, youth may share experiences of having their allergen waved in front of them or being chased with their allergens. When I expand beyond overt physical acts, many more people share experiences.

Although this is purely anecdotal and based on my experiences with a nonrepresentative sample through FARE, many young people with food allergy appear to experience teasing, mocking and criticism related to their allergy. For example, I frequently hear about youth with food allergy being asked questions such as “Does this look good to you?” while watching peers voraciously eat their allergens in front of their face, or being told “I would die if I couldn’t eat X.” Existing measures of bullying or teasing may not capture such insensitive questions and comments that youth with food allergy may experience.

Healio: How common are extreme incidents like this in Texas?

Engel: This is an important question that is difficult to gauge from the existing literature, which has not specifically focused on “extreme incidents” like this one in Texas. Our greatest knowledge in this area likely comes from studies that assess overt physical actions.

In one recent study of 121 youth with food allergy aged 9 to 15 years, 41 youth reported food allergy-related bullying experiences. Of these, 21 experienced overt physical acts, such as having an allergen waved in their face or thrown at them, being forced to eat their allergen, being touched with their allergen, or having their food intentionally contaminated.

Although all types of bullying and teasing can engender adverse psychosocial effects, these physical acts are especially concerning due to their potential to cause a reaction. That being said, all types of bullying and teasing could lead to maladaptive self-management or risk-taking behaviors. For example, due to fear of negative social consequences, youth may eat food at a restaurant without disclosing their allergens or be reluctant to carry their autoinjector.

Healio: What impact could these behaviors have on the mental health of children with allergy?

Engel: These behaviors are likely to have negative effects on the mental health of children and adolescents with food allergy. In the general United States population, youth who experience bullying are more likely to experience depression, anxiety, suicidal ideation and self-injurious behaviors. In studies of youth with food allergy, food allergy-related bullying has been associated with feelings of sadness, depression, embarrassment, humiliation, loneliness and decreased quality of life. Children and adolescents with chronic medical conditions are already at heightened risk for a range of mental health conditions, and bullying may contribute to or exacerbate this relationship.

Healio: How can allergists screen their pediatric patients for mental health issues due to bullying?

Engel: In an ideal world, allergists would regularly screen pediatric patients for a range of mental health problems, as well as experiences of bullying. This is much more practical in multidisciplinary clinics, where mental health providers are part of the team. There is a plethora of validated brief measures to screen for anxiety and depression in general pediatric settings.

With regard to food allergy-related bullying, research supports asking children specific questions about their potential experiences, as opposed to simply asking if they have experienced bullying, and gaining perspectives from both the child and the caregiver. The EMPOWER Program Survey of Children with Food Allergy is perhaps the most comprehensive measure of food allergy-related bullying. It asks a variety of specific questions and includes forms for both youth and caregivers.

Healio: Do you have any recommendations for how allergists can discuss these issues with patients and their families?

Engel: Allergists should regularly discuss these issues with patients and their families. Youth may be reluctant to disclose bullying for a variety of reasons, so it is important that providers directly ask youth about both overt and covert acts of bullying. Additionally, allergists should ensure that caregivers are aware of the increased risk for bullying among youth with food allergy.

Research suggests that youth fare better when their parents know about their experiences of bullying and can help support them, yet a recent study revealed many parents were unaware of their children’s elevated risk for bullying due to food allergy. Given the prevalence of food allergy-related bullying, it should not be thought of as a “taboo topic” and instead a topic of discussion at routine visits.

Healio: What can allergists do to prevent similar incidents from happening in the future, both on an individual patient level and on a community level?

Engel: Allergists should take action on both the individual patient/family level, as well as on larger school and community levels.

On the patient level, allergists should engage in regular conversations about bullying with families, as well as administer standardized measures when suggested. Allergists and their team members could create evidence-based psychoeducational materials about the elevated risk and warning signs of bullying among youth with food allergy and distribute them in clinic. Patient education programs may also be helpful. For example, caregivers could learn how to effectively navigate school systems, and youth with food allergy could practice role playing difficult social scenarios.

On more distal levels, allergists can partner with schools and community organizations to offer educational programs, dispel common myths and misconceptions about food allergy, and highlight the dire consequences of bullying. Incorporating information about food allergy-related bullying, as well as epinephrine education, into health classes may go a long way. Additionally, allergists should help ensure that policies are inclusive and likely to socially help, rather than harm, youth with food allergy.

References:

For more information:

Melissa Engel, MA, can be reached at melissa.lauren.engel@emory.edu.