Young people feel uneasy managing their allergy around peers, prefer family
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Key takeaways:
- Survey participants said food allergy education was one of the solutions for making management easier.
- They also noted that education on epinephrine autoinjectors for their peers would be helpful.
Adolescents and young adults reported being less comfortable managing their allergy around their peers than with their families, according to a study published in The Journal of Allergy and Clinical Immunology.
“My prior studies found that adolescents take risks with their food allergies, and a telling finding was that when asked what can be done to make things easier for them, peer education, by people other than the teen with food allergy, was a significant wish,” Scott H. Sicherer, MD, FAAP, professor of pediatrics and director of the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai, told Healio.
The research team conducted 100 surveys on a sample of adolescents and young adults aged 14 to 21 years (mean age, 17.2 years; 47% female; 73% white) with an IgE mediated food allergy from the Jaffe Food Allergy Institute at the Icahn School of Medicine at Mount Sinai.
The most common food allergies among participants were peanut and tree nuts (both 71%), followed by sesame (34%), milk (24%), egg (21%) and shellfish (13%). Comorbid conditions included asthma (30%) and eczema (24%).
According to survey results, adolescents and young adults reported being “comfortable” or “very comfortable” addressing restaurant staff about their food allergies when their family was present compared with their friends (83% vs. 50%, respectively; P < .01).
Participants also reported that they were less likely to inform their friends about their allergic reactions compared with family members (81% vs. 96% “likely” or “very likely”; P < .01). They felt that family members understood their food allergy “well” or “very well” more than their friends (93% vs. 39%; P < .01).
Feeling peer pressure “at least sometimes” to eat certain foods (18%) and not carry epinephrine injectors (9%) was reported by participants. As many as 20% of participants reported that they “at least sometimes” felt harassed, teased or bullied by their friends due to their food allergy.
When asked about which interventions might be helpful with managing their food allergy, 68% responded that having their peers educated on food allergies would make it easier to avoid allergens. This compared with only 18% citing education for family members would be helpful (P < .01).
Other responses to this question included educating restaurants (71%), larger meal selections (51%), improving food labeling (43%), signage in public spaces (37%) and nothing (8%). One participant indicated that providing larger print on food labels would also be helpful.
More participants reported educating their peers vs. family on epinephrine autoinjectors would make it easier to use them in public (53% vs. 19%; P < .01).
Other responses selected in order to make carrying and using epinephrine autoinjectors easier included: availability in public places (67%), simpler means to carry (44%), frequent tutorials (13%) and nothing (16%). “Other” responses included having autoinjector use taught in health class and for the devices to be smaller.
“This study very much confirmed my suspicions — the adolescents were more comfortable speaking to restaurant staff when with family rather than friends, and less likely to alert friends compared to family about them having an allergic reaction,” Sicherer said. “This reluctance is, of course, dangerous.”
The solutions that the teens and young adults suggested or found important in the survey serve as a great message for schools and industry workers to be aware of, according to Sicherer.
“I think the lesson for doctors is to open the discussion with teens and give advice along the lines that peers can be supportive,” he said. “Make sure they know about the allergy. Tell them: Wouldn’t you want to know if your friend had a medical concern that you should be aware of to keep them safe or help them if they needed help?”
Sicherer further explained that peer pressure could be a significant factor and that sharing information with peers about allergies can be empowering and increase safety, especially since many people are on special diets such as gluten-free, low lactose, low sugar, low fat and vegan, as well as follow specific diets for religious reasons, so food allergy needs are not something to be embarrassed about.
“After all, friends don’t want you to get sick and would support carrying medications and having careful discussions at restaurants,” he said.
Perspective
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I was thrilled to see a study published on the social pressure experienced by adolescents and young adults with food allergy. This is a very important yet often underacknowledged area, with much of the research focused on difficulties experienced by young children with food allergy and their caregivers. Much of the literature on food allergy-related psychosocial challenges relies on caregiver report. While the psychosocial burden of food allergy management may decrease for parents as children mature, adolescents and young adults may be met with novel psychosocial challenges, such as communicating their allergies with friends, romantic partners, and restaurant personnel. Since 2019, I have led improv-style workshops on navigating awkward social situations at the annual Food Allergy Research and Education (FARE) Summit. The return of these sessions year after year highlights the need for greater awareness in this area.
Developmentally, adolescents often strive to fit in; communicating a “difference,” and one that is often stigmatized in society, may feel quite uncomfortable. This, coupled with adolescents’ heightened attunement to social reward and propensity toward risk-taking, makes these findings unsurprising yet imperative to address. Ideally, education and training could be provided across multiple levels. One participant mentioned education in health classes; several adolescents I have worked with have suggested that students be trained in anaphylaxis awareness and epinephrine administration just like they are often trained in CPR and AED use. If peers of individuals with food allergies understood the gravity of the condition and were prepared to act in an emergency, as family members presumably do, I would expect the differences between comfort in situations with family versus friends to decrease.
Perspective
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Unfortunately, I am not surprised by the findings from this study.
In working with parents of children and adolescents managing food allergies, parents often express concerns about their teen’s willingness to engage in food allergy safety strategies such as consistently carrying epinephrine, self-advocating, informing friends about food allergies, and speaking up during an allergic reaction.
Adolescence is an important time for brain development. It’s a time when teens begin to mature, which also comes with new opportunities for risk-taking behaviors as teens face new challenges and navigate decision-making. This is in part due to the fact that the prefrontal cortex, or the area that is responsible for key skills such as decision-making and planning, continues to mature into the mid-to-late 20s.
Knowing that adolescents are navigating intense social pressures, want to feel like they belong, and view their friends as a second family whose opinions they deeply care about, it makes sense that they are less likely to do anything that makes them stand out or feel different or embarrassed.
Given all of these developmental factors, here are my recommendations for allergists and healthcare practitioners working with adolescents to help them navigate the social pressures with a willingness to engage in food allergy safety practices.
With adolescents
Meet without parents: If possible, reserve a portion of each appointment to meet with adolescents alone for honest discussions about their willingness and struggles with practicing food allergy safety strategies around peers.
Cost-risk-benefit discussions: Help adolescents consider different points of view about keeping themselves safe when with friends by exploring the costs, risks, and benefits of engaging in safety behaviors. Highlight the social-emotional benefits of educating friends, carrying epinephrine, and decreasing food allergy-related risks.
Meet them where they’re at: Take into consideration their personality, especially if they tend to be shy, and help them adapt food allergy management skills to be workable for them.
Assess for skills deficits: Especially when parental anxiety is a factor, assess for knowledge and skills gaps, as some adolescents may not have had enough opportunities to build and practice allergy management skills in the years leading up to adolescence due to parental hesitancy.
With parents
Prior to the teen years, talk with parents about the goal of transitioning food allergy management responsibilities during adolescence and how skill-building happens over time. Encourage age-appropriate opportunities to practice safety skills, including carrying epinephrine and self-advocating so that these skills are well-developed (and consistently utilized) by adolescence.
Finally, if an adolescent is having a hard time figuring out how to practice their own food allergy management skills while navigating social pressures, consider a referral to an allergy-informed mental health practitioner who can help them with skill-building during the tumultuous teen years. The Food Allergy Counseling Directory is a resource to help them locate an allergy-informed therapist in their state.
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