Cognitive-Behavioral Intervention for Anxiety Associated With Food Allergy in a Clinical Sample of Children: Feasibility, Acceptability, and Proof-of-Concept in Children

To evaluate the practicality, acceptability, and proof of principle of a novel cognitive behavioral intervention called Food Allergy Bravery (FAB) in children with food allergy-related anxiety.

The study involved 10 children (aged 8–12 years; mean age = 10.12, 80% female) with confirmed and well-controlled IgE-mediated food allergy or allergies (FA/FAs), along with excessive anxiety and medically unnecessary and impairing anxious avoidance related specifically to their FA. One or both parents were also included.

Three cohorts of families were offered a FAB course via group sessions coded by a psychologist and an allergist. Anxiety was graded via the Screen for Child Anxiety Related Emotional Disorders (SCARED) and a version of the Scale of Food Allergy Anxiety (SOFAA). Quality of life was graded via the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF). FAB satisfaction and helpfulness were rated via a posttreatment questionnaire.

All families completed at least 5 of 6 active treatment sessions. All parents rated the treatment overall for their child and themselves as “very helpful” or “extremely helpful,” and all children were rated as much or very much improved on the Clinical Global Impression scale at posttreatment. Both child and parent ratings showed significant reductions on the SOFAA from pretreatment to posttreatment and follow-up (P < .01), as well as on the SCARED from pretreatment to follow-up (P < .05). There were significant increases in health-related quality of life on FAQLQ-PF scores from pretreatment to posttreatment and follow-up (P < .05).

Both children and parents reported symptom improvement across multiple domains, and these gains were maintained 2 to 4 months after active treatment.

This is the first study of a group outpatient psychosocial treatment in children diagnosed with clinically impairing allergy-related anxiety. Its impressively positive results show feasibility, acceptability, and proof of concept of FAB, laying a foundation for larger randomized controlled trials. Limitations include small sample size, lack of control group, and narrow child age range. Allergy practices may benefit by involving trained providers offering exposure-based therapy.