Evaluation of a Behavioral Intervention to Promote Food Allergy Self-Management Among Early Adolescents: The Food Allergy Mastery Program

Food allergy is highly prevalent, burdensome, and stressful. Food allergy affects up to 7% of adolescents in the United States, or two adolescents in every classroom. Anaphylaxis, a multi-systemic allergic reaction, can be fatal if not treated with epinephrine quickly, and can only be prevented by strict allergen avoidance. The daily burden of allergen avoidance, fear about allergen exposure and emergency treatment, and food allergy-related bullying can incur stress and anxiety on patients and caregivers and is related to lower quality of life. Daily adherence to allergen avoidance and emergency preparedness is challenging, particularly during early adolescence when executive functioning skills are still developing, conformity to peer norms are predominant, and food allergy management responsibility shifts from caregiver to adolescent. Most fatal food-induced anaphylaxis cases occur during adolescence/young adulthood when allergens are unknowingly ingested away from home, treatment with epinephrine is delayed, and/or asthma is comorbid. Early adolescents need to be equipped with the skills and self-efficacy to engage in food allergy self-management behaviors that minimize accidental allergen exposures and increase the probability of prompt treatment. Behavioral interventions that promote illness self-management and adjustment are common in other chronic illness populations. However, there are no evidence-based behavioral interventions that promote early adolescent food allergy self-management. The proposed research project will evaluate a novel behavioral intervention that promotes early adolescent food allergy self-management and adjustment through 1) food allergy education, 2) problem-solving, communication, assertiveness, and anxiety management skill building, and 3) peer support. The Food Allergy Mastery (FAM) program is a 6-session food allergy self-management program that will be delivered to early adolescents with food allergy, a high-risk population that is growing in size, and a primary caregiver by a trained interventionist. The specific aims are: 1) To evaluate the intervention’s impact on food allergy knowledge and self-management skills, 2) To determine the intervention’s impact on food allergy self-management behavior and psychosocial functioning and healthcare utilization, and as an exploratory aim 3) to determine if early adolescents’ race/ethnicity moderates response to treatment, including food allergy knowledge, skills, self-management behavior, psychosocial functioning, and healthcare utilization. The study has the potential to positively impact the health care utilization of youth with food allergy by evaluating a scalable behavioral intervention for adolescents and their caregivers. The intervention will equip youth with food allergy knowledge and self-management skills by bolstering their food allergy-related knowledge and problem-solving, social skills, and social support and attenuating food allergy anxiety. Successful development and implementation of the FAM program that promotes the attainment of integration of food allergy into daily life has the potential to decrease health care utilization reducing emergency visits and improve food allergy-related quality of life.