Food allergy-related bullying in children: Prevalence and psychosocial burden from a mixed-methods study

Food allergy-related bullying (FARB) is an underrecognized phenomenon that combines the psychosocial harm of peer victimization with the potential for serious physical consequences from allergen exposure. Despite its relevance, data on FARB in Italy are scarce. This study aimed to investigate the prevalence, forms, and lived experiences of FARB among school-aged children and adolescents with food allergy (FA) using a mixed-methods approach.

We conducted an observational cross-sectional study between June 2023 and April 2024 at a tertiary Pediatric Allergy Unit in Naples, Italy, adopting a sequential explanatory mixed-method design. Quantitative data on bullying prevalence were collected using the Italian-adapted Olweus Bully/Victim Questionnaire. Qualitative data were obtained through semi-structured interviews and analyzed using Interpretative Phenomenological Analysis to explore emotional impact, coping strategies, and perceived support.

Seventy-three children with FA (mean age 10.6 years; 69.9% male) were included. In the previous 2 months, 35.6% reported at least one bullying episode, and 27.4% identified FA as the specific motive. FARB most frequently involved verbal insults, social exclusion, and rumor spreading, mainly occurring in classrooms and perpetrated by small peer groups. Only 60% of affected children reported the episodes, primarily to parents. Qualitative findings highlighted emotional distress, hypervigilance, social withdrawal, inconsistent adult responses, and a strong desire for greater school awareness and protection.

FARB is a frequent and multifaceted form of victimization with relevant psychosocial and potential physical implications. Preventive strategies should integrate FA management into school-based anti-bullying policies, staff training, and inclusive educational interventions.