Age-Related Food Aversion and Anxiety Represent Primary Patient Barriers to Food Oral Immunotherapy

Jordan Trevisonno; Carina Venter; Kaci Pickett-Nairne; Philippe Bégin; Scott B Cameron; Edmond S Chan; Victoria E Cook; Jeffrey M Factor; Marion Groetch; Mariam A Hanna; Douglas H Jones; Richard L Wasserman; Douglas P Mack

doi:10.1016/j.jaip.2024.03.014

Age-Related Food Aversion and Anxiety Represent Primary Patient Barriers to Food Oral Immunotherapy

J Allergy Clin Immunol Pract. 2024 Mar 14:S2213-2198(24)00276-9. doi: 10.1016/j.jaip.2024.03.014. Online ahead of print.

Authors

Affiliations

¹ Division of Allergy, McMaster University, Hamilton, ON, Canada.
² Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado, Aurora, Colo.
³ Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colo.
⁴ Section of Allergy, Department of Pediatrics, CHU Sainte-Justine, Montréal, QC, Canada; Section of Allergy, Department of Medicine, CHUM, Montréal, QC, Canada.
⁵ Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC, Canada.
⁶ Division of Allergy, Department of Pediatrics, British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada; Community Allergy Clinic, Victoria, BC, Canada.
⁷ University of Connecticut School of Medicine, Farmington, Conn.
⁸ Division of Pediatric Allergy & Immunology, Icahn School of Medicine at Mount Sinai, New York, NY.
⁹ Department of Pediatrics, McMaster University, Hamilton, ON, Canada.
¹⁰ Global Food Initiative LLC, Clearfield, Utah.
¹¹ Department of Pediatrics, Medical City Children's Hospital, Dallas, Texas.
¹² Department of Pediatrics, McMaster University, Hamilton, ON, Canada. Electronic address: mackd1@mcmaster.ca.

PMID: 38492666
DOI: 10.1016/j.jaip.2024.03.014

Abstract

Background: Although oral immunotherapy (OIT) for food allergy is a reasonable treatment option, barriers to this procedure's implementation have not been extensively evaluated from a patient perspective.

Objective: We evaluated the barriers patients face during OIT administration, including anxiety and taste aversion, and the role of health care professionals, especially dietitians.

Methods: A survey in Canada and the United States involved families currently enrolled in food OIT programs.

Results: Of responses from 379 participants, fear of reaction was the most common barrier to OIT initiation, with 45.6% reporting it being a "very significant" barrier with other fears reported. However, taste aversion represented the prominent obstacle to continuation. Taste aversion was associated with a slower buildup (P = .02) and a reduction in dose (P = .002). Taste aversion was a strongly age-dependent barrier for initiation (P < .001) and continuation (P < .002), with older children over 6 years of age reporting it as a very significant barrier (P < .001). Boredom was reported as a concern for specific allergens such as peanut, egg, sesame, and hazelnuts (P < .05), emphasizing the need for diverse food options. Notably, 59.9% of respondents mixed OIT foods with sweet items. Despite these dietary concerns, dietitians were underutilized, with only 9.5% of respondents having seen a dietitian and the majority finding dietitian support helpful with greater certainty about the exact dose (P < .001).

Conclusions: Taste aversion and anxiety represent primary patient-related barriers to OIT. Taste aversion was highly age dependent, with older patients being more affected. Dietitians and psychology support were underutilized, representing a critical target to improve adherence and OIT success.

Keywords: Adherence; Anxiety; Barriers; Dietitian; Food allergy; Food oral immunotherapy; Oral immunotherapy; Psychologist; Taste aversion.