Targeted cognitive behavioral therapy can reduce fear of food allergies in children and parents

Targeted cognitive behavioral therapy can reduce fear of food allergies in children and parents

Children with food allergies often have increased anxiety, as do their parents, about the risk of occasional exposure to food allergens. They also wonder whether they should avoid social situations involving food and whether medical interventions such as oral food challenges and oral immunotherapy are safe. A new study in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI), shows that targeted cognitive behavioral therapy (CBT) can significantly reduce fear of food allergies (FAA) in both children and parents.

To our knowledge, this is the first study of outpatient use of CBT in a sample of children diagnosed with an anxiety disorder related to their food allergy. We found that although it was a small sample of 10 children, 100% of children and their parents showed symptom improvement as reported by multiple sources (child, parent, therapist) and in multiple domains (specific food allergy anxiety, general anxiety, and health-related quality of life).

Jonathan Spergel, MD, PhD, allergist, ACAAI member and study co-author

The study included a follow-up assessment two to four months after active treatment, the results of which suggested that benefits were maintained.

Study participants were 10 children aged 8 to 12 years (80% female) who were specifically referred by their allergists for evaluation and treatment of FAA. Children were required to have confirmed IgE-mediated food allergies/allergies that were well controlled, as well as excessive anxiety and medically unnecessary and disabling anxious avoidance specifically related to their food allergy. Cognitive behavioral therapy involved 5-8 “close-up sessions” with the patient, with each session typically lasting between 30 and 90 minutes, depending on whether it was a group or individual session. An allergist or a psychiatrist led the sessions.

“A variety of graded exposures, such as sniffing their allergen, touching their allergen, or eating an unnecessarily feared and avoided food, were performed by the entire group in each session and assigned as homework,” said Katherine Dahlsgaard, PhD, a CBT therapist who worked with the families and lead author of the study. "One or both parents of 100% of the children completed a treatment satisfaction questionnaire after treatment. Parents rated the treatment as very satisfactory and helpful, and all 10 children were rated as much or very improved."

Although the sample size was small and randomized trials have yet to be conducted, allergists and others who work with children with FAA, including mental health professionals, may benefit from CBT in their treatment efforts. “This manual treatment was brief – just six sessions – and can be delivered in allergist offices by nurse practitioners or other providers,” said Megan Lewis, CRNP and co-author of the study.

Allergists are specially trained to test, diagnose and treat food allergies. To find an allergist near you who can help you create a personalized plan for managing your child's food allergies and helping them live their best life, use the ACAAI Allergist Finder.

Source:

American College of Allergy, Asthma and Immunology

Reference:

Dahlsgaard, KK, et al. (2022) Cognitive behavioral intervention for anxiety associated with food allergy in a clinical sample of children. Annals of Allergy, Asthma and Immunology. doi.org/10.1016/j.anai.2022.09.021.

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