New issue of food allergy: Phobia of anaphylaxis in pediatric patients

Abstract

Your 10-year-old patient with peanut allergy has come for her annual appointment. Her allergy was identified after an anaphylactic event as a toddler that she does not remember. The main concern described by parents is not the food allergy, but anxiety. Over the last year-after experiencing minor allergic symptoms that did not require epinephrine-the child has become increasingly fearful of accidental crosscontamination, even under the most remote of circumstances. She no longer sits near someone eating peanut butter and runs from a room if she smells it. She has stopped eating with friends at school or going on playdates without her mother. There is overwashing of hands and ''constant'' seeking of reassurance that minor stomach aches or ''feeling hot'' aren't signs of an impending allergic reaction. The patient's mother has grown preoccupied with news reports of anaphylactic deaths that are shared on social media. She complains that her husband is ''too cavalier'' about food safety while he snaps back that his wife has become ''too coddling.'' He then begrudgingly admits that he recently removed all peanut products from the family home, such that their daughter can have ''one safe place'' where she ''doesn't have to feel anxious about her allergy.'' This has led to conflicts with her siblings, who want to eat peanut butter sandwiches and enjoy their Halloween candy in relative peace. You wonder if this level of anxiety warrants referral to a mental health provider, and which type? So many of your patients present with comorbid anxiety these days, and you want to make sure they receive evidence-based, effective care.