Whether or not a caregiver feels anxious and fearful about their child with food allergies may depend on whether their allergist offers the family anticipatory guidance, according to a recent survey.

“Our study aimed to understand the extent to which allergists may impact patients’ and families’ anxiety and worry related to food allergy,” Victoria Nguyen, DO, and her coauthors wrote. “Specifically, we sought to understand if discussions, anticipatory guidance, and interventions offered by the allergist led to a decrease, increase, or no change in caregiver food allergy anxiety.”

Nguyen is an assistant professor of allergy and immunology at the Wexner Medical Center at The Ohio State University in Columbus, Ohio. The study was published recently in the Annals of Allergy, Asthma & Immunology.

Food allergy in children is on the rise, with current incidence rates estimated at between 8% and 9% globally. Although oral immunotherapy is now available, allergen avoidance and emergency preparedness are still the first lines of defense.

Despite negligible food allergy mortality rates, outsized fear over accidental allergen exposure can lead families to experience “anxiety and worry, decreased quality of life, and restriction in travel and social gatherings,” Nguyen and colleagues wrote.

Nguyen and her colleagues distributed a survey and consent information across various social media platforms, along with the inclusion criteria that a survey-taker’s child must have a clinical diagnosis of at least one immunoglobulin E-mediated food allergy. Surveys were collected from February 2023 to April 2023.

The last section of the 69-question survey included a validated tool for measuring caregiver anxiety. The Worry About Food Allergy (WAFA) instrument scores self-reported food allergy-related anxiety on a scale of 0-4, with higher scores signifying greater concern.

The 419 (out of 496 respondents) qualified survey-takers were overwhelmingly women (98%; n = 408), White individuals (89%; n = 372), and educated (postsecondary education) (94%; n = 394). The respondents lived across 36 US states, Canada, Europe, and South America.

Children of the survey-takers were mostly White individuals (84%; n = 354), boys (68%; n = 284), and had a mean age of 3 years (84%; n = 354). Almost half (49%; n = 203) of the survey-takers reported having children with three or more food allergies. The same numbers were reported as having received treatment with epinephrine at least once in their life (49%; n = 203).

Included in the survey was a 10-point Likert scale to rate how comfortable respondents were discussing anxiety or worry with the child’s allergist. The results were that 52% (n = 217) of caregivers rated their comfort level at 7 or higher; 19% (n = 81) rated their comfort level at 3 or less.

Just under half of the survey-takers (47%, n = 196) reported discussing anxiety or worry with their allergist, while 29% (n = 121) reported that they wished they could have discussed anxiety or worry with their allergist but were unable to for reasons such as not thinking that their allergist could help, not having enough time during the visit, or not wanting to discuss anxiety in front of their child.

The average of mean WAFA scores was 1.65 (SD, 1.01), with 1 being the lowest, and 4 being the highest score.

When asked how their last visit with their child’s allergist influenced their food allergy-related worry and anxiety, 32% (n = 135) of caregivers reported a decrease, 29% (n = 123) reported an increase, and 38% (n = 161) reported no change in their anxiety levels. Respondents who reported their worry and anxiety decreased after seeing the allergist were more likely to have a lower WAFA score (median, 1.11; IQR, 0.59-1.7). Those who endorsed an increase in worry and anxiety after seeing the allergist were more likely to have a higher WAFA score (median, 2.00; IQR, 1.32-2.89; P < .0001).

Only 16% (n = 68) of the survey-takers reported their child’s allergist had offered strategies to decrease either their own anxiety or that of their child. This subgroup was twice as likely to report a decrease in food allergy-related anxiety and worry compared with those who did not receive such guidance (odds ratio [OR], 2.13; 95% CI, 1.26-3.62).

Meanwhile, a third of caregivers (32%; n = 135) reported the allergist helped their child feel more comfortable about managing their food allergies. These families were four times more likely to report a decrease in food allergy-related anxiety and worry compared with the allergists who did not (OR, 4.01; 95% CI, 2.59-6.22).

“Allergists can play an essential role in helping their patients manage anxiety and worry. The first step is to understand the complex nature of food allergy and the vast amount of information available to families that can further intensify anxiety and worry,” the corresponding author on the study, Irene Mikhail, MD, told Medscape Medical News. Mikhail is an allergist at Nationwide Children’s Hospital in Columbus, Ohio.

“Food allergy management has shifted dramatically over time and this is likely a reason why many allergists do not offer uniform advice if they are not keeping up with the latest research. However, anticipatory guidance is key and helpful for patients, as seen in our study,” said Nguyen.

Edwin Kim, MD, Division Chief of Pediatric Allergy and Immunology at The University of North Carolina at Chapel Hill, said in an interview that one of the primary reasons for the shift in the field is advances in treatment. 

“I think omalizumab and other treatments like exposure and immunotherapy have helped us frame things differently,” Kim said in an interview. “It helped us create some steps to managing food allergy.”

Prior to the advent of these treatments, Kim said that allergists didn’t have many ways to help patients and often frightened them by saying that even though the chance was slim, they might die from their food allergy. What’s different now, he said, is we can actually do something about it, so now our language can reflect that food allergy is not the end of the world.

Kim said for there to be a more pervasive shift in how allergists handle anticipatory guidance, it’s important for medical schools and professional associations for allergy and immunology to focus on it.

Nguyen and Mikhail had no relevant financial disclosures. Kim disclosed having scientific advisory board membership with ALK-Abelló, DBV Technologies, Kenota Health, and Ukko, Inc; receiving consultancy for AllerGenis, Allergy Therapeutics Ltd, Belhaven Pharma, Duke Clinical Research Institute, Genentech, and Nutricia; and receiving grant support to his institution from the National Institute of Allergy and Infectious Diseases and Food Allergy Research and Education.