Food allergy-related social anxiety: Novel conceptualization of an important but overlooked construct

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.