By Carolyn Crist

(Reuters Health) – Parents of children with food allergies should acknowledge their kids’ anxiety, as well as their own, a group of allergy experts advises.

Food allergies affect children of different ages in different ways and can influence relationships with classmates, family and the general public, according to the study in the Annals of Allergy, Asthma & Immunology.

“Quality of life issues related to food allergies are ubiquitous,” said co-author Dr. Ruchi Gupta, director of the Center for Food Allergy and Asthma Research at the Northwestern Feinberg School of Medicine in Chicago.

“Coping with food allergies impacts relationship skills with peers and classmates, emerging independence and sense of self-efficacy, social skills and confidence, willingness to participate in sports teams, dating and more,” she told Reuters Health by email. “Coping is an individual internal experience, too: Feelings of worry and anxiety can color all thinking and generate anxiety about many life experiences.”

About 8% of children in the U.S. have been diagnosed with a food allergy, according to the American Academy of Pediatrics. Allergic reactions to foods tend to be among the most severe, and potentially life-threatening, the study authors note.

Anaphylaxis, the most severe allergic reaction, can be reversed with a shot of epinephrine from an auto-injector like the EpiPen.

To examine the challenges children with life-threatening food allergies and their families encounter, which ones cause the most anxiety and what positive coping patterns work best, Gupta and colleagues interviewed six board-certified allergists who treat a large number of children with food allergies.

Overall, the allergists said, diagnosis, management and treatment occur along a spectrum, and “it’s not a one size fits all” practice. Younger children, for instance, may not be especially anxious about food, but their parents often are. Although older children may have better understanding and control of their food allergy, they participate in more independent activities, which can create heightened parental anxiety.

Kids with food allergies experience anxiety as a result of their parents’ stress, as well as fear of the auto-injector needle, anaphylaxis, food allergy tests and oral immunotherapy. The “fallout” that follows an allergic reaction can also be complex and interfere with everyday functioning. Successfully using epinephrine, however, can build confidence and bring a sense of relief after facing the unknown.

The allergists also talked about creating thoughtful and balanced communication, having credible health information to share with children, and supporting a positive feedback loop between parents and children rather than one that builds anxiety. “Parents should be encouraged to transfer their knowledge to children, not all of their worries,” one expert remarked.

“Psychosocial coping with food allergies can be understood and managed when clear communication is present between parents and children and between healthcare providers and patients,” Gupta said. “It is a balance between lots of sound medical information and a good understanding of a child’s risks and coping resources.”

Coping is often impeded by misinformation about food allergies, the experts said, so it’s important for parents to receive consistent messaging and counseling for the family, if necessary.

“You are taking care of the kids, but you are (also) managing the family unit, as you should be,” one allergist said.

Brochures, apps, virtual groups and other educational materials can offer scientifically informed resources for parents and kids to manage food allergies. Gupta and colleagues are now collecting information in an online survey about the coping strategies and integrative medicine that parents and children have used.

“It’s important for families to know that it’s normal to be stressed about food allergy and feel overwhelmed, worried, sad or frustrated at times,” said Linda Herbert, director of the Psychosocial Services Program for the Division of Allergy and Immunology at Children’s National Hospital in Washington, D.C.

“But it’s equally important to know that they can get help from a professional,” Herbert, who wasn’t involved in the study, told Reuters Health by email. “The mental health and allergy communities are paying more and more attention to the needs of food allergy families, and we are working hard to increase the number of mental health professionals who are equipped to do so.”

SOURCE: Annals of Allergy, Asthma & Immunology, online February 25, 2020.