By helping to build up protection from accidental exposure, oral immunotherapy for the treatment of food allergy can allow children and adolescents to try new restaurants, travel, and attend birthday parties or go to college with fewer concerns about life-threatening reactions. However, treatment can be anxiety-provoking, as it requires patients to consume substances that may have been long avoided, and doing so can result in symptoms of allergic reactions that may be reminiscent of anaphylaxis. With the hypothesis that patients may be largely unaware that such symptoms are not just unfortunate side effects with which patients must cope, but can be a positive signal of treatment progressing toward desensitization, Lauren C. Howe, PhD, and colleagues sought to determine if changing mindsets about non-life-threatening symptoms during oral immunotherapy from unfortunate side effects to signs of treatment efficacy would reduce patient anxiety.

For a study published in The Journal of Allergy and Clinical Immunology: In Practice, patients aged 7-17 who had undergone oral immunotherapy and their families were informed that non-life-threatening symptoms during therapy were unfortunate side effects of treatment or that such symptoms could signal desensitization. All patients and families participated monthly in activities to reinforce these symptom mindsets and learned the same safety information and strategies for managing symptoms.

Compared with families informed that symptoms are side effects, “patients and their parents who learned that symptoms can be positive signals of treatment efficacy were less anxious when they experienced symptoms during oral immunotherapy,” explains Dr. Howe. “They were also less likely to contact on-call support about symptoms, to experience symptoms as treatment progressed to a one-peanut maintenance dose, or to skip or reduce their doses. And they showed a greater increase in peanut-specific blood IgG4 levels.”

Given that the intervention was conducted with one provider in one clinical setting, Dr. Howe notes that the results should be validated in larger studies. In the meantime, she suggests that “physicians can take steps to help patients deliberately adopt adaptive mindsets about symptoms,” adding that “informing patients when symptoms of a treatment are signs of healing may help improve their treatment experience and outcomes.”

References

Changing Patient Mindsets about Non–Life-Threatening Symptoms During Oral Immunotherapy: A Randomized Clinical Trial
https://www.sciencedirect.com/science/article/pii/S2213219819300753