Background/Objectives: Patients with food allergy (FA) may exhibit dysfunctional eating behaviours and/or food aversions that extend beyond the necessary allergen elimination diet and may result in avoidant/restrictive food intake disorder (ARFID) or food neophobia (FN); however, no data are available on adults. This study aimed to explore ARFID, FN, FA anxiety, and eating styles in adults with FA, analysing influences of sociodemographic and clinical factors. Methods: This cross-sectional preliminary study involved 79 adults with FA, who completed the Nine Item ARFID screen (NIAS), Food Neophobia Scale (FNS), Scale of Food Allergy Anxiety (SOFAA), and Dutch Eating Behaviour Questionnaire (DEBQ-brief). Pearson and Spearman correlation coefficients and multiple linear regressions were performed (p < 0.05). Results: In total, 25% and 73% of participants scored positively for ARFID and FN, respectively. A positive correlation was observed between FN and ARFID levels (p < 0.006), and between FN and FA anxiety (p < 0.001). Current psychological problems positively correlated with ARFID (p = 0.004), FN (p = 0.006), and FA anxiety scores (p = 0.03). Restrained eating was positively associated with female gender (p < 0.001), and ARFID (p = 0.002) and FN scores (p = 0.028). External eating was negatively correlated with ARFID (p = 0.004). Adrenaline auto-injector (AAI) prescription was negatively associated with ARFID (p < 001) and restrained eating (p = 0.006), while previous anaphylaxis was negatively associated with ARFID (p = 0.020) and positively associated with external eating (p = 0.021). Multiple logistic regression models confirmed that restrained eating was associated with a higher probability of both ARFID (p = 0.031) and FN (p = 0.074). Conclusions: Clinicians should be aware of the risk of ARFID and FN among adult patients with FA and recommend appropriate psychological and dietary support. Further studies are needed to better understand the protective and precipitating factors of ARFID and FN to develop effective prevention and treatment strategies.

GA2LEN and EFA propose minimum specifications for all industrialised countries/regions to work towards to support students with food allergies in educational settings. We reviewed research and legislation and gained feedback from over 100 patient and professional groups. We built shared expectations around: 1. training all school staff about what food allergy is, the symptoms of allergic reactions, what to do in an emergency, and when and how to use and store devices that laypeople can use to administer adrenaline (epinephrine). 2. preventing allergic reactions by using clear labelling on school menus and prepacked and non-prepacked foods and regular cleaning where students eat. 3. preparing for serious allergic reactions, with written emergency action plans for every student with food allergies, legislation allowing schools to store adrenaline for anyone who needs it in an emergency (not just those prescribed it), and training and legal safeguards for staff administering adrenaline. 4. including affected students by discussing food allergy in the curriculum, raising awareness among all students and caregivers and reviewing school processes regularly. It is time for national and international action at the policy level. Patient groups, education networks and professional societies all play a role in campaigning for shared next steps.

Background/Objectives: The beliefs about a disease and its treatment determine how patients and caregivers manage and adapt to the illness. The study aimed to explore the QoL and mental health of children with food allergy (FA), and parental illness perception, analyzing influences of sociodemographic and clinical factors and associations between constructs. Methods: This cross-sectional study involved 79 parents of children (3–12 years) with FA, who completed the Food Allergy Quality of Life Questionnaire—Parent Form (FAQLQ_PF), Strengths and Difficulties Questionnaire (SDQ), and Brief Illness Perception Questionnaire (B-IPQ). Pearson correlation coefficient and multiple linear regressions were performed. Results: FAQLQ score was positively associated (0.28) with SDQ score, particularly internalizing problems (0.33), and with B-IPQ score (0.64), consequences for the child and parents (0.66), timeline (0.43), and emotional representation (0.63). SDQ score was negatively associated with parental control (−0.27) and coherence (−0.24), while internalizing problems were negatively associated with parental control (−0.23) and positively associated with timeline (0.24). A greater number of allergens was associated with a worse QoL (p < 0.05). Previous anaphylaxis was associated with higher illness identity (p < 0.05). An age between 7 and 12 years was associated with lower control and coherence. In the final model, higher scores on internalizing problems, timeline, and emotional representation were associated with poorer child QoL (p < 0.001). Conclusions: It is crucial to understand and explore illness perception, as well as focus on psychosocial–emotional aspects of FA in both children and parents. A multidisciplinary approach addressing medical and psychological aspects of FA should be implemented to ensure optimal QoL.

BackgroundAnaphylaxis is a life-threatening allergic reaction, associated with mental health burden in patients and caregivers. Intramuscular adrenaline via autoinjector (AAI) is the recommended treatment for the management of anaphylaxis in non-hospital settings; however, AAIs are underused. This study aimed to assess parental self-efficacy in managing child's anaphylaxis and administering AAI to understand how to effectively support families.MethodsSeventy-five parents of children with severe food allergy completed a questionnaire to measure parental self-efficacy in managing child food-induced anaphylaxis (PSEMA). We conducted an exploratory factor analysis with 12 items, using principal axis factoring as the extraction method. We used Cronbach's alpha to assess the internal consistency of the factors. We used the Anderson-Rubin approach to estimate the factors' scores and provide a kernel density estimate of their distributions. An assessment through linear regression between the total factors' score and total score was performed.ResultsA five-factor model was identified. The factors that emerged were conceptually related to "F1. Manage Injection," "F2. Manage AAI Device," "F3. Manage Anaphylaxis," "F4. Manage Emergency," and "F5. Manage Emotions." The questionnaire demonstrated high internal consistency, with a Cronbach's alpha of 0.91 (95% CI: 0.87-0.94) The variation in the total score explained 90% of the variation in the factor score.ConclusionsThe PSEMA questionnaire promises to be an easy and effective tool for measuring parents' self-efficacy in managing anaphylaxis and AAI, allowing clinicians to identify gaps in education and provide effective training.

This Anaphylaxis Manifesto calls on communities to prioritise 10 practical actions to improve the lives of people at risk of serious allergic reactions. The Global Allergy and Asthma European Network and the European Federation of Allergy and Airways Diseases Patients' Associations (EFA) compiled patient-centric priorities. We used qualitative consensus methods, research evidence and feedback from over 200 patient groups, stakeholder organisations and healthcare professionals. We encourage healthcare, education and food organisations to collaborate with people at risk of serious allergic reactions to tackle safety, anxiety and financial burdens for individuals and societies. Key priorities for prevention include awareness-raising campaigns for the public and professionals, school and workplace initiatives and mandatory precautionary allergen labels on food. Priorities for improving immediate and long-term management include educating healthcare professionals, patients and schools about when and how to use adrenaline, funding two approved adrenaline devices for everyone at risk, and facilitating access to allergy specialists. Integrated care pathways should include clinical and non-clinical management options such as individualised risk assessment and quality of life assessment, self-management plans, dietetic and psychosocial support and peer support. Organisations around the world are committing to work together towards these priorities.

The COVID-19 outbreak has substantially impacted people's lives, especially for more vulnerable individuals.1, 2 Among patients with food allergy (FA), difficulties accessing “safe” foods and health services have been commonly reported, with significantly overall poorer subjective wellbeing.2 Patients with FA undergoing oral immunotherapy (OIT) may have been particularly affected by the pandemic since the protocol requires many in-hospital visits to gradually increase the allergen ingestion due to the risk of severe reactions.3 Such a risk can be a source of anxiety for patients and families.4, 5 The COVID-19 pandemic led to an unprecedented change in clinical procedures, with fast implementation of telemedicine programs.6 Telemedicine has been reported as a beneficial means to support allergic patients, including those undergoing OIT.1 Italy was the first European country impacted by the pandemic and Veneto was the region hit fourth hardest. Since 2011, in our Food Allergy Centre in Padua, an expert support telephone line is accessible 24/7, for patients undergoing OIT. This cross-sectional retrospective survey aimed to evaluate patients/parents attitudes and satisfaction about the service during the first year of the pandemic in the Veneto region. We wanted to better understand participants' needs and perceived benefits concerning the helpline to continue to support patients post pandemic with more tailored and effective interventions. In March 2021, adults and parents of a child medically diagnosed with IgE-mediated FA undergoing OIT were asked to complete an online survey on their experiences of using and satisfaction with the helpline over the last 12 months. From a sample of 110 eligible participants, 85 (77%) accepted giving written consent. The Padua University Hospital Ethics Committee approved the study. The survey evaluated user experience, specifically (a) Reasons for using the helpline, (b) Alternative actions if the service was not available and (c) Satisfaction with the service. Reliability for “Satisfaction” was found excellent (α = 0.94). Since Spearman correlations between the items ranged from r = 0.82–0.97, we created a composite mean Satisfaction score. We performed the chi–square test for categorical variables and t-tests or ANOVA for continuous dependent variables. A simple logistic regression examined the effect of the OIT phase and a linear regression model factors predicted helpline use. Sixty-five parents and 20 adult patients completed the survey (Table 1), 83% female. Patients had mean age 15 years, (SD = 8.22), 57% male. OIT was for milk (N = 58, 68.2%), egg (N = 23, 27.1%), and wheat (N = 4, 4.7%); up-dosing phase (N = 56, 68%), and maintenance (N = 29, 34.1%). Fifty-four percent called the helpline at least once. There was no significant relationship (p < 0.05) between sex and helpline access. No significant differences were found between the user/non-user groups on education, age, FA number, or OIT allergen. A significant difference was found for the user groups OIT phase (t = 2.69; p = 0.009). More calls were made in the up-dosing (N = 36, 78%, M = 1.2; SD = 1.0) compared to the maintenance phase (N = 10, 22%, M = 0.69; SD = 1.0). In logistic regression, those in up-dosing were over three times as likely to call the helpline as those in maintenance (OR = 3.6, p = 0.04; 95% CI 1.1–12.2). Concerning the reasons why the helpline was accessed and alternative actions if the service had not been available (Table 2), “clarifications” was the most frequent reason cited (70%), followed by “mild/moderate symptoms” (57%); 35% “reassurance” and 11% “suspected anaphylaxis.” If not available, the majority (87%) would have visited their physician (49%) or the hospital (38%). Users reported a very high level of satisfaction (M = 4.96; SD = 0.18). A strong correlation was found between items and composite Satisfaction (p < 0.001). The overall regression model was significant (F = 5.27; p < 0.001) with the number of calls predicting satisfaction (β = 0.14, p ≤ 0.006; 95% CI 0.1–0.23). OIT is a challenging process for patients and their families. It is prolonged and requires daily allergen consumption, and adverse reactions are often experienced.4, 7 The 24/7 availability of experts can provide important support that makes a difference for patients/families. In the present study, more than half of the respondents used the service at least once, with very high satisfaction. The more often respondents called, the more satisfied they were. Most users called the service to clarify issues and concerns around OIT. Telehealth methods may present a resource-friendly complementary way to ensure that families are safely monitored, provided with continuing support and education, and that parental/patient concerns are addressed. Support is essential for maintaining safety and long-term success.8 Although additional research is needed, the helpline may facilitate adherence by quickly addressing concerns around side effects, and related issues. Indeed, patients in the up-dosing phase were over three times as likely to call as those in the maintenance phase. This result may suggest when support is needed most, helping to prevent drop-out or dissatisfaction with treatment. These findings are also in line with a previous study reporting that 24-h telephone access to experts significantly improved the disease-specific quality of life of children and families with life-threatening FA compared with usual clinical care.9 We acknowledge some limitations of this study: firstly, an ad-hoc measure was used, although we found excellent Cronbach's alpha. Secondly, the sample size was relatively small and self-selected; however, the participation of 77% may reduce potential bias. Evaluating new ways to promote the continuity and safety of care is crucial. A 24/7 expert support telephone line for patients undergoing OIT has proved to be useful to support patient and family adherence and compliance, while also minimizing hospital access. Therefore, these services should be integrated more widely on a permanent basis for FA care, including OIT.6 The present findings can increase understanding or ways to potentially enhance OIT care pathways in the post-pandemic era. Laura Polloni: Conceptualization (equal); data curation (equal); formal analysis (equal); investigation (equal); methodology (equal); project administration (lead); supervision (equal); writing – original draft (lead); writing – review & editing (equal). Antonella Muraro: Conceptualization (equal); investigation (equal); methodology (equal); project administration (lead); resources (lead); supervision (lead); writing – original draft (equal); writing – review & editing (equal). Audrey DunnGalvin: Conceptualization (equal); data curation (equal); formal analysis (lead); investigation (equal); methodology (equal); supervision (equal); writing – original draft (equal); writing – review & editing (equal). Roberta Bonaguro: Data curation (equal); writing – review & editing (equal. Francesca Lazzarotto: Data curation (equal); writing – review & editing (equal). Laura Morandini: Data curation (equal); writing – review & editing (equal). Rossana Schiavo: Supervision (equal); writing – review & editing (equal). Alice Toniolo: Data curation (equal); writing – review & editing (equal). No financial support was awarded relating to this paper. Nothing to declare.

Abstract Background Oral immunotherapy (OIT) is a promising treatment for food allergy (FA) however it is a challenging process for patients and parents. Induction can generate stress and anxiety. This may in turn affect their motivation and ability to cope with OIT challenges. Objective This study aimed to investigate psychological needs and support to patients/parents undergoing food OIT assessing participants' main characteristics, reasons for seeking psychological support, OIT phase and related psychological difficulties, type and timing of treatments and patients' perception of the effectiveness of the intervention. Methods This is an observational, retrospective study. 50 psychological interventions required for OIT related problems were selected consecutively in a Referral Centre in North‐Eastern Italy. All patients had a medical diagnosis of FA and were undergoing OIT or had just discontinued it. Data were collected from hospital records. A descriptive statistical analysis was performed. Results 66% of patients asked for psychological support for the initial phase (e.g., oral food challenge, first maintenance doses), 20% during the up‐dosing phase, 8% during maintenance and 6% after discontinuation. 70% of treatments were required mainly because of emotional problems including dysfunctional anxiety and mood disorders, increased distress and excessive worry and/or fear related to OIT; 20% because of difficulties in managing OIT; 10% because of eating difficulties; 50% of patients reported recent anaphylaxis. All patients reported improvement and felt the psychological intervention was helpful. Conclusion It is recommended to evaluate the psychological needs in profiling patients and families suitable to OIT and offer specific psychological support when needed.

Background Alexithymia is a multifaceted personality construct described as "a lack of words to express emotions" that includes difficulty identifying feelings, difficulty describing feelings and a concrete, externally oriented cognitive style. Among patients with food allergy (FA) alexithymia has been found higher than in general population and associated with dysfunctional coping strategies. Childhood traumatic experiences and/or dysfunctional parent-child relationship can contribute to alexithymia. The study aimed to explore possible associations between child alexithymia and mother alexithymia and anxiety, as well as previous anaphylaxis. Methods Sixty-five mother-child pairs have been recruited. Children had a medical diagnosis of FA. The Toronto Alexithymia Scale-20 was used to assess alexithymia in participants. The State-Trait Anxiety Inventory was used to assess trait anxiety in mothers. Statistical analysis was performed to investigate the influence of variables sex, previous anaphylaxis, and adrenaline auto-injector prescription on child and mother's alexithymia and to explore possible association between maternal and child alexithymia. Results A substantial percentage of children were alexithymic (21.5%) or borderline (33.8%), while mothers' frequencies were lower and in line with prevalence in general population. Child alexithymia was positively associated with previous anaphylaxis and mothers' trait anxiety (p < .05). Mother trait anxiety was also associated with maternal alexithymia. Furthermore, a positive association between child and mother alexithymia has been found. Conclusions Clinicians must be aware of the role of alexithymia and its association with maternal anxiety and previous anaphylaxis in children with FA, encouraging seeking psychological support when needed. A multidisciplinary patient-centered approach should be put in place for the effective care of FA.

BackgroundAnaphylaxis is a life-threatening event, but it is frequently undertreated in pediatric patients with food allergies. Previous studies showed that auto-injectable adrenaline (AAI) is underused by patients and parents. This is especially troubling since fatal anaphylaxis has been associated with delayed adrenaline administration.ObjectivesThis study aimed to investigate parental practice and knowledge in anaphylaxis management, and perceived barriers and facilitators in using AAI.ResultsA retrospective survey was completed by 75 parents (41 mothers, 34 fathers) of children with food allergy and AAI prescription attending the Food Allergy Referral Center of Veneto, Italy. Results showed poor parental preparedness and reluctance to use AAI despite a high/moderate self-rated knowledge (median total score of 23–min. 3, max. 30). Most parents (77%) declared they were carrying AAI but only 20% used it in case of a severe reaction. Most reported Fear/Fear of making mistakes (46 parents) and Concern about possible side effects as barriers (35), while Poor knowledge of the correct AAI use (1) and Lack of knowledge/ incorrect assessment of symptoms (2) were reported less frequently. Theoretical-practical courses for parents on AAI use (65), Psycho-education/Psychological support (3) for better dealing with the emotional aspects of anaphylaxis and Written instructions (1) have been suggested as main facilitators.ConclusionUnderstanding parents' experience and perspective on managing anaphylaxis is crucial to implement effective educational programs. A multidisciplinary approach should be considered.

Anaphylaxis is a serious, generalized or systemic, allergic, or hypersensitivity reaction that can be life-threatening or fatal.1 It constitutes the most frightening allergic reaction, placing patients at high risk of death. Understandably, this can be an emotionally traumatic experience. Chung et al2 found that 12% of adults who had experienced anaphylaxis fulfilled the diagnostic criteria for posttraumatic stress disorder (PTSD). Weiss and Marsac3 reported in a pilot study that children with food allergy (FA) may be at risk for posttraumatic stress symptoms and those with a history of anaphylaxis at even more risk.

BACKGROUND:Despite a relatively high risk for allergic reactions, including anaphylaxis, schools are not sufficiently trained and confident in handling children suffering from food allergy. This study aimed to measure the improvement of school personnel's self-efficacy in managing food allergy and anaphylaxis at school after a specific multidisciplinary training course.METHODS:A total of 592 teachers and school caretakers completed the School Personnel Self-Efficacy-Food Allergy and Anaphylaxis Questionnaire (S.PER.SE-FAAQ) before and after the course. The median difference, along with I quartile and III quartile, in scores between baseline and post-intervention assessment was calculated. A conditional regression tree was fitted for each outcome measured after the educational intervention.RESULTS:At baseline, school personnel reported low self-efficacy in anaphylaxis management (AM), especially in recognizing anaphylaxis symptoms and administering proper drugs. After the specific multidisciplinary training course, all scores improved. AM scores particularly showed a significant increase. School personnel's post-training self-efficacy was found to be related to initial levels. Some indicative threshold values emerged. Remarkably, participants with a low self-efficacy at baseline seemed to particularly benefit from the training.CONCLUSIONS:Results highlighted the effectiveness of specific multidisciplinary training courses in improving teachers' and school caretakers' self-efficacy in managing food allergy and anaphylaxis. The S.PER.SE-FAAQ is confirmed to be an easy and helpful tool to assess the level of food allergy and anaphylaxis management in the school staff and training effectiveness.

Pediatric Allergy and ImmunologyVolume 29, Issue 5 p. 557-561 LETTER TO THE EDITOR Attachment and alexithymia in adolescents with food allergy: A developmental hypothesis Laura Polloni, Laura Polloni laura.polloni@aopd.veneto.it orcid.org/0000-0002-0158-359X Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorIleana Baldi, Ileana Baldi Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, ItalySearch for more papers by this authorEmilia Ferruzza, Emilia Ferruzza Department of Developmental Psychology and Socialization, University of Padua, Padua, ItalySearch for more papers by this authorFrancesca Lazzarotto, Francesca Lazzarotto Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorRoberta Bonaguro, Roberta Bonaguro Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorAlice Toniolo, Alice Toniolo Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorNicolò Celegato, Nicolò Celegato Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorDario Gregori, Dario Gregori Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, ItalySearch for more papers by this authorAntonella Muraro, Antonella Muraro orcid.org/0000-0002-5026-5862 Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this author Laura Polloni, Laura Polloni laura.polloni@aopd.veneto.it orcid.org/0000-0002-0158-359X Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorIleana Baldi, Ileana Baldi Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, ItalySearch for more papers by this authorEmilia Ferruzza, Emilia Ferruzza Department of Developmental Psychology and Socialization, University of Padua, Padua, ItalySearch for more papers by this authorFrancesca Lazzarotto, Francesca Lazzarotto Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorRoberta Bonaguro, Roberta Bonaguro Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorAlice Toniolo, Alice Toniolo Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorNicolò Celegato, Nicolò Celegato Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this authorDario Gregori, Dario Gregori Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, ItalySearch for more papers by this authorAntonella Muraro, Antonella Muraro orcid.org/0000-0002-5026-5862 Department of Women and Child Health, Referral Centre for Food Allergy Diagnosis and Treatment, Veneto Region, Padua University Hospital, Padua, ItalySearch for more papers by this author First published: 25 March 2018 https://doi.org/10.1111/pai.12897Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume29, Issue5August 2018Pages 557-561 RelatedInformation

BACKGROUND:Food allergy is major public health concern affecting nearly 15 million Americans and 80 million Europeans. Risk of anaphylaxis and implications for social activities affect patients' quality of life and psychological well-being. We previously found that young patients reported higher levels of alexithymia (difficulty in recognizing and expressing emotions) compared with healthy peers and may influence affect, management style and clinical outcomes. This study aimed to explore links between coping strategies, alexithymia and anxiety among food-allergic adolescents and young adults.METHODS:Ninety-two patients with IgE-mediated food allergy (mean age 18.6 years) completed Coping Orientation to Problems Experienced Inventory, Toronto Alexithymia Scale and Trait Anxiety subscale of State-Trait Anxiety Inventory. Multivariate analyses of variance assessed differences and associations between subgroups on the scales.RESULTS:Significant differences found between alexithymia levels in coping style were explained by Avoidance strategies. 'Avoidance' had the highest contribution in explaining alexithymia, followed by trait anxiety, age, anaphylaxis and social support. Respondents with higher alexithymia use avoidance as coping strategy over and above other coping strategies such as problem-solving and positive thinking, are younger, will have experienced anaphylaxis and will have lower social support.CONCLUSIONS:Recognizing the specific role of affect regulation in health behaviours may constitute an important step in supporting patients to explore more adaptive strategies.

BACKGROUND:Food allergy is a common immunologic disease that includes potentially fatal reactions. It impacts considerably on patients' social life including close interpersonal relationships. Attachment theory provides a theoretic framework to evaluate the quality of close interpersonal relationships in chronic disorders. Attachment insecurity, mainly characterized by attachment avoidance, has been found in a variety of health conditions, but still needs to be investigated in food allergy. The study aimed to investigate attachment, as attitude to close interpersonal relationships, among food-allergic young patients, compared to healthy controls.METHODS:This is a cross-sectional study involving patients suffering from IgE-mediated food allergy sequentially recruited and matched to healthy controls for age and gender. The Attachment Style Questionnaire (ASQ) was used to assess five factors and two attachment dimensions (Anxiety-Avoidance). Associations with anaphylaxis and adrenaline prescription were explored among patients.RESULTS:174 participants were assessed (female=45%; mean age=17.51; SD=4.26). Food-allergic patients reported significantly higher levels of Discomfort with Closeness (P<.05), Relationships as Secondary (P<.05) and Attachment Avoidance (P<.0001) compared to controls.CONCLUSIONS:Clinicians should be aware of implications of insecure attachment for health and illness. They should support patients in limiting social impairment finding a balance between safety and psychologic well-being.

BACKGROUND:Inappropriate dietary eliminations may impair quality of life, affect children's growth and unnecessarily impact on healthcare costs. Previous retrospective studies reported that around 25% of children continue a food-avoidance diet despite a negative oral food challenge (OFC). A definite pattern has not been found yet for patients not reintroducing the food. This study aimed to examine the role of child's nutritional attitudes and maternal anxiety in reintroducing food after a negative OFC.METHODS:A prospective study was conducted involving 81 mothers of children with IgE-mediated food allergy. They completed a survey on nutritional behaviour and attitudes and the State-Trait Anxiety Inventory on the day of OFC and 6 months later.RESULTS:In total, 11.1% of children never or rarely ate the food after a negative OFC. Consumption of the reintroduced food is positively correlated to child's interest in tasting new foods before and after OFC and to changes in child's nutritional habits after OFC. It is negatively correlated to monotony of the diet after OFC. No correlations were found with other participants' characteristics or maternal anxiety. State anxiety significantly decreased after the OFC. A correlation was found between trait and state anxiety and the degree of change in nutritional habits after OFC.CONCLUSIONS:Evaluating child's approach towards food before the OFC is a promising approach to identify patients at risk of food reintroduction failure. Furthermore, it underlined the importance of reassessing food consumption in all patients after a negative OFC and supporting patients in the reintroduction of food.

BACKGROUND:A major drawback of oral immunotherapy for food allergy is the possibility of severe side-effects. We assessed both safety and efficacy of a low allergenic hydrolysed egg (HydE) preparation used in a double-blind placebo-controlled randomized study in egg allergic children.METHODS:In a pilot multicentre study, 29 egg allergic patients (aged 1-5.5 years) were administered daily for 6 months 9 g HydE or placebo in a blinded, randomized manner. Safety was verified by oral food challenge to assess tolerance towards HydE at the start and efficacy by an open oral food challenge (OFC, primary outcome) at the end. Additionally, changes in basophil activation and specific IgE and IgG4 were assessed.RESULTS:All egg allergic patients randomized to HydE (n = 15) tolerated the full dose at day 1 and received the maintenance dose from the start at home. No statistically significant difference was observed on the final OFC (36% and 21% had a negative OFC in the treatment and placebo groups, respectively). Specific IgG4 levels increased, while both CD203c+ and CD63+ basophils decreased significantly more over time in the treatment than in the placebo group.CONCLUSIONS:HydE can be regarded as a safe, low allergenic product to use in children allergic to egg. Although not significant, HydE given for 6 months increased numerically the proportion of patients becoming tolerant to egg. HydE induced a modulation of the immune response towards better tolerance. A longer treatment period and/or a higher dose may improve the clinical outcome and should be evaluated.

Background: Food allergy affects up to 4-7% European schoolchildren. Studies identified important shortcomings on food allergy and anaphylaxis management in schools. In social cognitive theory, personal beliefs in own capabilities influence choices, effort levels, perseverance and performance accomplishments. This study aimed to investigate school personnel's self-efficacy in managing food allergy and anaphylaxis, providing a valid instrument to deeply understand how to support schools to effectively manage students at risk of food reactions.Methods: A total of 440 schoolteachers and caretakers from north-east Italy completed a questionnaire assessing self-efficacy in managing food allergy and anaphylaxis at school. Exploratory factor analysis was performed. Factors' internal consistency was evaluated using Cronbach's alpha. Factors' scores were estimated using Bartlett approach, and kernel density estimate of distributions was provided. Descriptive statistics explored school personnel's self-efficacy. A regression model assessed the influence of gender, school, job and previous experience.Results: Two factors emerged from exploratory factor analysis related to anaphylaxis management (AM) and food allergy management (FAM). The two subscales both showed good internal consistency. School personnel showed lower self-efficacy in recognizing symptoms, administering drugs and guaranteeing full participation to extra-curricular activities to food-allergic students. Participants who previously had food-allergic students showed a significantly increased self-efficacy in AM and a significantly decreased self-efficacy in FAM.Conclusions: The study supports the use of self-efficacy scale to identify specific areas where teachers' confidence in their ability to care for food-allergic students is especially weak. This would empower the development of training programs specifically tailored to the needs of teachers and caregivers.