Food-Allergy-Specific Anxiety Linked to Distress, Functional Impairment

Clara Westwell-Roper, MD, PhD

A new study from British Colombia concluded that food-allergy-specific anxiety (FAA) contributed to both distress and functional impairment among parents of children with food allergy (FA).

Investigators Clara Westwell-Roper, MD, PhD, British Colombia Children’s Hospital Research Institute, suggested that current FA-specific parent measures fail to adequately capture the dimensions of FAA, and called for further work to improve upon this area of study.

They also noted that the quality of life as well as healthy family functioning could be impaired when parenting a child with FA.

In their systematic review, Westwell-Roper and colleagues intended to clarify the concept of FAA, and to determine the extent to which existing FA-specific outcome measures capture symptoms of parental distress and FAA.

The Methods

Investigators first conducted a systematic review, taking relevant studies from databases such as Medline, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials (CENTRAL) from database inclusion dates through to August 25, 2020.

Search terms covered 3 primary concepts in pediatric FA, parents and caregivers, and anxiety, worries, fear, or distress. Articles were eligible if they were empirical studies in English, whether qualitative or quantitative.

Data that were extracted from full text articles included country and dates of study, funding sources, study design, qualitative methodology, intervention type, inclusion/exclusion criteria, number of participants, demographic information, FA information, aspects of distress quantified or described, and more.

Investigators would go on to summarize major themes related to FAA using a concept analysis framework used for the characterization of dimensions of anxiety in other contexts.

A total of 1886 abstracts were screened during the review, with 131 full texts being assessed for eligibility.

Overall, 98 studies met inclusion criteria and examined parenting distress or anxiety associated with parenting a child with FA. Specifically, 23 studies used qualitative or mixed methods while 75 were quantitative.

The Findings

Westwell-Roper and colleagues reported that a large subset of parents in most studies had endorsed distress related to their child’s FA.

Additionally, a majority of the studies featured in the review (78%) described emotional aspects of distress, with the most common form being anxiety specific to FA (63%).

Other studies detailed stress (42%), distress (16%), general anxiety (37%), FA-related worry (35%) or fear (25%), sadness or sorrow (12%), and depression (10%).

Regarding cognitive dimensions, investigators cited fears about the consequences of allergen exposure (57%), challenges maintaining social identity or being understood (20%), child life transitions (20%), uncertainty about the child’s future (16%) or outcomes of diagnostic/treatment procedures (8%), and trauma or recurrent/intrusive thoughts about previous FA symptoms such as anaphylaxis (5%).

Several allergy-related factors as well as medical and psychosocial interventions were associated with reduced parental anxiety and distress, though affective, cognitive, and behavioral dimensions of FAA were only partially addressed by existing measures.

The limitations detailed in the study suggested that more research was warranted to improve the assessment and monitoring of FAA and its impacts.

Investigators recommended the initiation of diagnostic tools.

“Development and validation of a screening tool for FAA encompassing the dimensions defined by existing studies may aid clinicians in providing more comprehensive assessment and management options for children with FA and their families,” the team wrote.

The study, “Food-allergy-specific anxiety and distress in parents of children with food allergy: A systematic review,” was published online in Pediatric Allergy and Immunology.