Food allergy anxiety deemed a unique subtype with high youth, caregiver concordance

Key takeaways:

• There were strong correlations between youth and caregiver scores on the Scales of Food Allergy Anxiety.
• This assessment and another anxiety assessment not related to food allergy had low correlations.

SAN DIEGO — Food allergy anxiety is a unique subtype of anxiety that merits specific assessment and tailored interventions, according to an abstract presented here.

“Pediatric food allergy-related anxiety has received increasing attention in recent years, which may reflect both the growing prevalence of food allergy and heightened awareness of mental health challenges in young people,” Melissa L. Engel, PhD, postdoctoral fellow, Center for Food Allergy and Asthma Research (CFAAR), Feinberg School of Medicine, told Healio.

Research into the psychosocial burden of pediatric food allergy has grown recently, Engel continued.

“Interestingly, this field of study initially focused on quality of life but has more recently zoomed in on anxiety, likely due to its significant negative impact on quality of life for children and families with food allergy,” she said.

Engel noted that food is everywhere in society and often is the center of daily social activities.

“For children and families with food allergy, seemingly ‘fun’ activities can induce fear, whether that be about fear of allergic reaction, fear of social exclusion, fear of perceived judgement, or other difficult experiences,” she said.

Presented at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress, the abstract included data from the ongoing FORWARD study.

The cohort included a “racially, ethnically, socioeconomically, and geographically diverse sample” of youth aged 8 to 18 years (mean age, 10.27 years; 62.4% male; 64.9% white) with a physician-diagnosed food allergy and their primary caregiver for a total of 165 dyads, Engel said.

“Families represented a range of household incomes, and youth represented a range of number of food allergens,” Engel said.

Youth and caregivers both completed the Scales of Food Allergy Anxiety (SOFAA) assessment, which Engel called “a relatively new tool for assessing a very specific type of anxiety — fear of allergic reaction.”

Caregivers also completed the FA Quality of Life-Parental Burden (FAQL-PB) assessment and the PROMIS-Anxiety Parent-Proxy assessment, which is not specific to food allergy.

Engel said that she and her colleagues were excited to deploy SOFAA as part of the FORWARD study and “to have the opportunity to examine caregiver-child concordance, as well as sociodemographic and clinical correlates and relationships with other anxiety-related constructs.”

There was a strong correlation between the caregiver and youth SOFAA scores (r = 0.62), the researchers said, adding that the factor structure for each reporter was similar (r = 0.63 between two sets of loadings).

“Discordant reporting is big challenge for anxiety research and clinical practice,” Engel said. “There are often great discrepancies between what children and adolescents report vs. what their parents report, making it difficult for researchers and clinicians to know what data to rely on or how to best combine.”

This concordance between reporters was high across composite scores for each individual item regardless of the youth’s age, the researchers continued. Mean SOFAA scores included 2.03 for the youth and 1.94 for the caregivers. Black youth, females and youth with more food allergies had higher SOFAA scores.

Also, food allergy anxiety and concordance between youth and caregivers both peaked at approximately age 14 years.

“With internalizing (eg, anxiety, depressive), parent-child concordance tends to decrease in adolescence, but that was not the case in our study. This may reflect the high behavioral component of many SOFAA items,” Engel said.

“In other words, many of these items (eg, washing hands, reading ingredient labels, not going to restaurants or sitting at regular lunch table) reflect observable behaviors that would likely render greater concordance than other types of food allergy-related worries (eg, fear of negative evaluation from others),” she continued.

Additionally, the associations between caregiver SOFAA scores and FAQL-PB scores were much stronger than the associations between caregiver SOFAA scores and PROMIS-Anxiety scores, the researchers said.

“Our results suggest that the SOFAA and PROMIS-Anxiety measures are capturing distinct constructs,” Engel said. “In other words, fear of exposure to allergen/allergic reaction/anaphylaxis is distinct from more general worries.”

Engel said this is significant for informing psychosocial research and interventions for patients with food allergy. It also suggests that treatments for food allergy-related anxiety probably need a more targeted approach, as opposed to general anxiety treatment, she added.

“These findings suggest that families with food allergy who are experiencing food allergy-related anxiety may benefit from psychosocial interventions specifically targeted their food allergy-related fears,” Engel said.

“This tailored treatment may be more effective than general anxiety interventions,” she continued. “It is critical that researchers and clinicians work towards developing and disseminating such treatments so that they can be both effective and accessible.”

Further, Engel noted that the media recently has brought great attention to “food allergy anxiety.”

“While increased awareness of the everyday difficulties of food allergy management is great, it is important to keep in mind that this anxiety is specific to food allergy and does not necessarily render food allergy patients at increased risk for broader worries or anxiety disorders,” she said.

“In my opinion, this is a reassuring message that may help to reduce the stigma associated with food allergy,” she said.

Reference:

• Many children with food allergies experience psychosocial burdens associated with food-allergy related bullying and anxiety. https://www.aaaai.org/about/news/news/2025/food. Published Feb. 10, 2025. Accessed Feb. 10, 2025.

For more information:

Melissa L. Engel, PhD, can be reached at mengel@luriechildrens.org.