Adolescents With Food Allergies Share Common Concerns

Adolescents with food allergies tend to share five areas of belief and concern related to how they manage their condition, according to a systematic review from the United Kingdom.

"Themes included navigating food allergy in different environments, carriage and use of adrenaline auto‐injectors, management of the risk of anaphylaxis, behavior and understanding of others, and food‐allergic identity," the authors write in Clinical and Translational Allergy.

"Adolescents with food allergy hold a variety of condition beliefs; some beliefs were related to behavior that could lead to an allergic reaction, while other beliefs were related to protective behaviors," they add. Other research suggests adolescents have the highest risk of fatal allergic reactions to food, they note.

To investigate beliefs about food allergies in adolescents, lead author Kristina L. Newman, PhD, a senior lecturer in the Department of Psychology at Nottingham Trent University, and colleagues searched standard academic databases and used reference chaining. They identified peer-reviewed papers in English of any design that sampled adolescents aged 11-19 years with food allergies, and that discussed or analyzed beliefs about food allergies.

The 20 studies that met their inclusion criteria were published from 2007-2020 and comprised around 900 participants in Canada, Ireland, the Netherlands, Denmark, Sweden, the UK, and across Europe.

The studies included interviews, focus groups, and questionnaires. The researchers used the Mixed Methods Appraisal Tool to assess the quality of the studies and exclude those of poor quality.

Five Areas of Belief and Concern

The researchers identified five themes in young people's beliefs about food allergies:

Navigating food allergy in different environments. Common concerns include travel and visits to friends, school, and restaurants; fear of missing out on what others are eating; skepticism about catering staff expertise; and embarrassment and difficulty involved in asking staff about allergens.
Carrying and using adrenaline auto ‐ injectors. Common attitudes include inconvenience and difficulty of use, fear of the needle, and anger or anxiety, as well as the device as a protective tool.
Managing anaphylaxis risk. Adolescents share uncertainty and difficulty in managing the risk. They engage in high-risk behaviors believed to be safe, severely dangerous, or both at the same time. They feel a need to eat foods that are potential allergens in order to fit in with others and to feel independent and in control, as well as a belief that some allergens, such as chocolate, are worth the risk. They may be dismissive of "may contain" allergen food labels and "may contain nut" warnings.
Beliefs and understanding of others. Concerns include a sense of feeling different and discriminated against by peers, a need to conceal their allergy, a need to talk with other adolescents with food allergy to feel understood, a need for classmates to learn about the condition, a lack of trust in adults' understanding of food allergy, a need to control their actions, a frustration that their allergy is dismissed or ignored by teachers and peers, and hypervigilance.
Food-allergic identity. Beliefs include powerlessness, food allergy as a large and unmanageable part of their identity, and a need to isolate, excessively wash their hands, or eat risky foods. Beliefs also include accepting their condition but not letting it define them, and optimism in their ability to balance risk or outgrow their allergy.

Jodi A. Shroba, MSN, RN, CPNP, the coordinator for the Food Allergy Program at Children's Mercy Kansas City, Missouri, welcomed the study's findings.

"The paper does a nice job of collecting common themes regarding food allergies and adolescents and of discussing many common concerns, practices, and beliefs of adolescents with food allergy," she told Medscape Medical News in an email.

Jodi Shroba

"As healthcare providers, it is important that we discuss these themes with our patients," Shroba advised. "Providers should discuss school and any concerns adolescents may have about their safety at school, and they should work with their patients' families to make safety plans for school.

"The lack of confidence in how to use adrenaline auto-injectors and the inconsistent carrying of potentially lifesaving medication is a real concern that needs to be addressed with teen patients," added Shroba, who was not involved in the study.

"A weakness of this study — a common weakness noted in research — is the lack of diversity of ethnicity and socioeconomic status that may affect some of the concerns," Shroba said. "For example, people with low socioeconomic status may not be able to afford medication or to buy allergy-friendly foods, which places them at higher risk of allergic reactions."

Megan O. Lewis, MSN, CRNP, a pediatric nurse practitioner and the program manager of the Food Allergy Bravery Clinic at Children's Hospital of Philadelphia, also welcomed the study.

"While the themes are not completely novel, the specific, targeted suggestions in the discussion help give practicing clinicians clarity," she said in an email.

"By identifying adolescents who struggle with anxiety, precautionary labeling, adrenaline (epinephrine) auto-injectors, and overall peer perceptions, clinicians can help them improve their health care behaviors.

Megan Lewis

"Individual study sample sizes were small; however, the authors speak to this challenge and to the limited information on the topic," noted Lewis, who was not associated with the current research. "It is my hope that further research can be done on interventions that can help shape and improve the beliefs of adolescents with food allergy."

Newman, co-author Angel Chater, PhD, MSc, Shroba, and Lewis report no relevant financial relationships. Co-author Rebecca Knibb, PhD, MSc, reports a financial relationship with Aimmune Therapeutics. The study was funded by Midlands Asthma and Allergy Research Association.

Clin Transl Allergy. Published online April 6, 2022. Full text

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