Engel Melissa L, Herbert Linda J, Ramos Ashley, Gupta Ruchi S, Warren Christopher M
Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.
Center for Food Allergy and Asthma Research and Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA.
Pediatr Allergy Immunol. 2025 Sep;36(9):e70189. doi: 10.1111/pai.70189.
Accumulating literature has highlighted the substantial psychosocial burden experienced by many young people with food allergy (FA), with growing attention to FA-related anxiety. To date, research and clinical practice addressing FA-related anxiety have focused specifically on understanding and alleviating the fear of allergic reaction, which can sometimes even lead to a specific phobia of anaphylaxis. Here, we propose an additional construct of FA-related social anxiety, which we define as fear of social scrutiny or negative evaluation by others due to FA. In social situations involving food, patients high in FA-related social anxiety often worry about judgment from others. For example, they may fear appearing different when eating alternative safe food, seeming demanding when asking to speak with a manager at a restaurant, or being perceived as difficult and unappreciative when declining offered but potentially unsafe food. We distinguish fear of social scrutiny from fear of anaphylaxis and illustrate how each fear may present in various social contexts across development. We offer a conceptual model of the broader construct of FA-related anxiety, as well as behavioral conceptualizations of FA-related social anxiety. When unrecognized or untreated, high levels of FA-related social anxiety may lead to maladaptive social impacts (e.g., missed social opportunities) or adverse allergy outcomes (e.g., reluctance to carry epinephrine or engage in self-advocacy, increasing propensity for allergic reaction). We discuss potential treatment implications, as well as the importance of future consideration of this construct in both research and clinical contexts.
越来越多的文献强调了许多食物过敏（FA）青少年所承受的巨大心理社会负担，人们对与FA相关的焦虑越来越关注。迄今为止，针对与FA相关焦虑的研究和临床实践具体集中在理解和缓解对过敏反应的恐惧上，这种恐惧有时甚至会导致对过敏反应的特定恐惧症。在此，我们提出了与FA相关的社交焦虑这一额外概念，我们将其定义为因FA而害怕受到他人的社会审视或负面评价。在涉及食物的社交场合中，FA相关社交焦虑程度高的患者常常担心他人的评判。例如，他们可能担心在吃替代安全食物时显得与众不同，在要求与餐厅经理交谈时显得要求苛刻，或者在拒绝提供的但可能不安全的食物时被认为难相处且不知感恩。我们将对社会审视的恐惧与对过敏反应的恐惧区分开来，并说明每种恐惧在不同发育阶段的各种社会情境中可能如何表现。我们提供了一个关于与FA相关焦虑这一更广泛概念的概念模型，以及与FA相关社交焦虑的行为概念化。如果未被识别或未得到治疗，高水平的与FA相关的社交焦虑可能会导致适应不良的社会影响（如错过社交机会）或不良的过敏后果（如不愿携带肾上腺素或进行自我维权，增加过敏反应的倾向）。我们讨论了潜在的治疗意义，以及未来在研究和临床环境中考虑这一概念的重要性。
