Awareness of Allergy Anxieties Spur Mental Health Referrals

The rising incidence of food allergies among children over the past decade appears to have been accompanied by a growing awareness among pediatric allergists that their patients may need mental health care to manage anxiety related to allergies, new research shows. 

From 2013 to 2023, referrals from pediatric allergists to mental health experts related to food allergies rose 11-fold at one children’s hospital system. Referrals in 2023 were 50% higher than in the period between 2018 and 2022, researchers reported at the 2024 annual scientific meeting of the American College of Allergy, Asthma and Immunology. 

“I hope this [study] increases awareness for pediatricians and allergists to discuss anxiety with families,” said David Stukus, MD, director of the Food Allergy Treatment Center at Nationwide Children’s Hospital in Columbus, Ohio, who helped conduct the research. “It is important to normalize this as much as possible as some people may see anxiety as a negative stigma.” 

Stukus and his colleagues said their study was not designed to draw conclusions about the incidence of pediatric anxiety linked to food allergies. 

“Our study was only designed to evaluate the number of referrals over time, and we observed a significant increase in referrals,” he said. “Our study was not designed to assess why or to evaluate if anxiety was increasing among all of our patients or the population of children with food allergy at large.” 

Clinicians and researchers now have a better understanding that anxiety is a component of having food allergies, “but I am not aware if anxiety itself has been increasing or we are simply more aware to assess for it and ask about it,” he said. 

The center was opened in 2021, and two psychologists were hired to help families and children dealing with anxiety in relation to allergies, Stukus said. His team conducted the study to characterize the use of the new psychology services. 

Stukus and his colleagues conducted a chart review of 250 referrals (141 male; median age, 9.5 years) to outpatient pediatric psychologists at Nationwide Children’s Hospital. The data included demographic information, medical history related to food allergies, and the number of psychology appointments. 

The findings revealed that 88% of patients were referred for psychological assessment owing to concerns related to food allergies, with 69% of the children exhibiting symptoms of anxiety related to their food restrictions. More than 50% had prior documented anaphylaxis. 

Of those referred, 60% followed through with at least one appointment, and on average, patients attended 5.5 follow-up appointments in the following year. 

Although awareness of the psychological impact of food allergies is growing, Stukus said not enough psychologists and therapists are available to help children. 

“And even those that are, they don’t necessarily have the background specific to food allergies and anxiety pertaining to those,” Stukus said. 

Zachary Rubin, MD, a pediatric allergist and immunologist at Oak Brook Allergists in Elmhurst, Illinois, said food allergies can play a large part in the mental health of patients. 

“When you have to constantly think about what you’re eating to make sure that it’s safe to consume and not have a severe allergic reaction, that can create a lot of problems psychologically,” Rubin said. “It is a chronic disease.” 

Kari Benson, PhD, a pediatric psychologist at Nationwide Children’s Hospital, said pediatricians usually refer patients to her when the anxiety begins to interfere with their day-to-day lives. 

“The kids have been avoiding eating lunch with their friends at school, maybe they only feel comfortable eating privately at their own table or at the allergen-free table, or maybe they won’t go to friends’ houses,” Benson said. “Or maybe they’re not necessarily avoiding anything but just that they spend a lot of their day worrying, and it’s really just having an impact on mood and stress.”