By Carolyn Crist
Many patients with life-threatening food allergies may feel anxious or overwhelmed at times, but it's rare for mental health professionals to be involved in their care, suggests a survey of U.S. centers of excellence in allergy treatment.
Allergy specialists and mental health professionals should work together to create easier pathways for patients to get mental health support, the survey team writes in the Journal of Allergy and Clinical Immunology: In Practice, online May 14.
"Food allergy is a chronic disease, but unique because you don't suffer from the pain of it every day, but every time you eat, you may be afraid that something bad might happen," said Dr. Marcus Shaker, a pediatric allergist at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, who wasn't involved in the survey.
About 8 percent of children in the U.S. have been diagnosed with a food allergy, according to the American Academy of Pediatrics.
"Depending on how that's framed and approached has profound implications, and it can start at an early age with family or doctors," Shaker told Reuters Health in a phone interview. "For some families, it doesn't affect them much, but for others, it's a completely different framing with constant vigilance and fear."
The survey was conducted by Linda Herbert of the Children's National Medical Center and George Washington University School of Medicine in Washington, D.C., and colleagues. It asked site coordinators at 28 Food Allergy Research and Education Clinical Network Centers of Excellence across the U.S. about the presence of psychiatrists, psychologists, social workers and other counselors in their practice, and the availability of mental health practitioners in the community through referrals.
Survey questions also asked about perceptions of the mental health concerns patients had in relation to managing their food allergies, allergy tests and challenges, and participation in clinical trials.
Overall, 22 of the centers of excellence were in hospital settings, including 16 that provided care only to children. Among the sites, five had a mental health professional in their division, full or part-time. More than half of the sites had a professional in their institution to whom they could refer patients, but fewer had a professional in the community for referral. Only four places had students who were receiving training in food allergy-related mental health concerns.
All but one of the survey participants said they observed food allergy-related mental health concerns in their patients, including both child and parent anxiety. Site coordinators thought mental health services could be most beneficial at the time of allergy diagnosis, before notable developmental transitions in kids and before food challenges occurred. Coordinators also said they had observed mental health concerns related to dosing, allergic reactions, epinephrine use in emergencies and food aversions.
Eighteen participants said they didn't have mental health support for clinical trial participants, but would like to have it. They also noted that they thought few mental health professionals had adequate food allergy knowledge to provide specialized care.
"We've seen kids develop a full-blown anxiety disorder, and if they do have a reaction, it can be traumatic and cause some degree of post-traumatic stress disorder that takes time to get back to where they were," said Dr. Amanda Cox of the Jaffe Food Allergy Institute in New York City, who wasn't involved in the survey.
The allergy and mental health communities should work together to create educational programs about food allergy for mental health professionals and primary care doctors, as well as expand the pool of professionals available for referrals, the study authors write.
"With any chronic health problem, it's important for parents and caregivers to observe how it affects how a person functions in the world," Cox said in a phone interview. "If it limits them and is stressful, it could be a problem that could benefit from good coping mechanisms."
J Allergy Clin Immunol Pract 2019.
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