December 24, 2025
4 min read
Key takeaways:
- Children and adolescents are afraid of being judged and feeling embarrassed or like a burden.
- 38.66% of respondents said they often or always were afraid of a negative social evaluation during birthday parties.
ORLANDO — Children and adolescents with food allergy often experience substantial fear of negative social evaluation, according to a poster presented at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
“People talk about food allergy anxiety. It’s getting a lot more attention. But the focus is really always on this fear of anaphylactic reaction,” Melissa L. Engel, PhD, postdoctoral fellow, Center for Food Allergy & Asthma Research, Northwestern University Feinberg School of Medicine, told Healio.
As the lead programming developer of teen outreach with Food Allergy Research & Education, Engel hosts monthly Child Chats and Teen Talks, which are virtual peer support programs for youth with food allergies.
Melissa L. Engel
“But in my work with teenagers with food allergies, there seems to be a lot of focus on fear of ruining the moment or ruining the plans, or just getting a lot of unwanted attention, or being different, or eating something different than other people,” she said.
During one Teen Talks session, Engel asked participants to name the hardest part of managing their allergies during birthday parties. Many participants said they could not eat the cake or that they were afraid of having an allergic reaction.
“But by far, the highest percentage of people said all of the unwanted attention that they get from not eating or from bringing something different,” Engel said. “And I was like, ‘OK, I actually need to study this, because that’s significant.’”
Engel and her colleagues proposed a construct for social anxiety related to food allergy, with a fear of negative social evaluation, including:
- worry about judgment from peers, adults or strangers;
- embarrassment of appearing different in an undesirable way;
- fear of being a burden to others;
- discomfort with disclosing their allergies or appropriately advocating; and
- avoiding social situations that may include food.
“Teenagers, developmentally, just want to be ‘normal,’” Engel said.
The researchers surveyed 215 youth (63.8% female; 66.5% white) with food allergy, including 31.3% in fifth through eighth grade, 45.8% in high school and 22.9% in post-secondary education. The cohort included participants from 37 states as well as five international youth. Also, 77.7% were allergic to multiple “top 9” allergens.
The survey asked these youth if they participated in 12 common social activities as well as how much fear of an allergic reaction and how much fear of negative social evaluation they experience on a scale of 1 to 5, with 1 meaning never and 5 meaning always.
Scores for eating lunch at school included 2.86 for worry about having an allergic reaction and 2.44 for worry about being negatively evaluated or judged by others, with 20% reporting that they do not eat lunch at school at all, at least partially because of their food allergy.
Scores for going to restaurants with friends included 3.27 for worry about an allergic reaction and 2.64 for worry about negative social evaluation or judgment, with 19.53% saying that they do not go to restaurants with friends, again at least partially due to their allergy.
When participants were asked about sleepovers, scores included 2.79 for worry about a reaction and 2.11 for worry about negative social evaluation or judgement, with 16.28% reporting that they do not go to sleepovers at least partially due to their allergy.
School activities involving food yielded scores of 3.15 for worry about a reaction and 2.77 for worry about negative social evaluation or judgment, with 11.63% reporting that they do not participate in these activities at least partially due to their allergy.
Dating scores included 3.22 for worry about a reaction and 2.84 for worry about negative social evaluation or judgment, with 9.3% reporting that they do not date at least partially due to their allergy.
When asked about birthday parties, scores included 3.26 for fear of a reaction and 2.88 for fear of negative social evaluation or judgement, with 3.26% saying they do not attend birthday parties, at least partially due to their food allergy.
Overall, Engel said that the percentages of respondents who avoided specific activities at least partially due to their allergies were “pretty significant.”
The researchers also stratified results based on percentages of respondents with scores of 4 or 5, indicating that respondents experienced these fears either often or always.
These percentages included 29.2% for allergic reactions and 24.64% for negative social evaluation during lunch at school, as well as 43.05% for allergic reactions and 30.46% for negative social evaluation when dining at restaurants with friends.
Similarly, percentages included 26.52% for reactions and 15.15% for negative social evaluation for sleepovers; 40.13% for reactions and 31.85% for negative social evaluation for school activities that involve food; 40.63% for reactions and 35.94% for negative social evaluation for dating; and 44.85% for reactions and 38.66% for negative social evaluation for birthday parties.
“There were substantial proportions of youth that were reporting each fear in all of these settings,” Engel said.
These findings indicate that allergists and primary care providers should ask patients if they are avoiding activities because of their allergies, she said.
“A lot of times, avoidance is good for preventing allergic reactions,” Engel said. “But from a social and emotional perspective, excessive avoidance can interfere with living a healthy life.”
Children and adolescents should engage in developmentally appropriate activities as well as effective food allergy management, she said.
“For anxiety, in general, the best treatment is exposure — like doing anything you’re scared of,” Engel said. “The social component would be going to the birthday party anyway, but maybe bringing your own food.”
Proximity challenges, where patients with food allergy get closer and closer to their allergens in controlled situations, could help these patients feel comfortable sitting at a table with other people as they eat, Engel suggested.
Also, Engel noted that the Scale of Food Allergy Anxiety measures fear of anaphylaxis and other allergic reactions. These findings and other research may inform the development of a similar tool for measuring the social fears associated with food allergy.
“Ideally, we could combine these measures to create one scale that could be disseminated in allergy clinics,” she said.
The researchers then would be able to establish a clinical cutoff that would suggest referral for treatment, Engel added.
“The treatment needs to be informed by the underlying fear,” she said.
Engel and her colleagues are now producing a manuscript based on these findings and on qualitative responses provided by the participants as well.
“It’s especially interesting to see what teens actually have to say about their food allergy-related fears in these situations, not simply on a numerical scale, but in their own words,” she said. “That is in the works.”
For more information:
Melissa L. Engel, PhD, can be reached at mengel@luriechildrens.org.
Sources/Disclosures
Source:
Engel ML, et al. Expanding understanding of food allergy anxiety: From fear of anaphylaxis to fear of social scrutiny. Presented at: ACAAI Annual Scientific Meeting; Nov. 6-10, 2025; Orlando.
Disclosures:
Engel reports no relevant financial disclosures.
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