Prevalence of Avoidant/Restrictive Food Intake Disorder (ARFID) in children with and without food allergy

Emerging research suggests those with food allergy may have a higher risk of eating and feeding disorders; however, data on the prevalence of Avoidant/Restrictive Food Intake Disorder (ARFID) among individuals with food allergy is limited. We examined whether possible ARFID in 10-year-old children was more common in children with or without food allergy.

The HealthNuts study recruited 5276 one-year-olds across Melbourne, Australia who were followed-up at ages 4, 6, and 10 years. Food allergy was assessed at each age with skin prick tests, clinical history, and/or oral food challenges. The Food Allergy Quality of Life Parent Form (FAQLQ-PF) capturing food allergy anxiety was completed for those with suspected food allergy. The ARFID assessment tool 'Eating Disorders in Youth Questionnaire (EDY-Q)' was completed by children participating in their age 10 assessment after 10 April 2019.

A total of 951 children completed the EDY-Q, of whom 102 had a current food allergy. The prevalence of possible ARFID was similar among children with current food allergy, 23% (95% CI 15-32) compared to without, 21% (95% CI 18-24). When considering food allergy anxiety (reported on FAQLQ-PF) as a symptom of possible ARFID (a variant not captured by EDY-Q), an additional 10 children (of 102) with food allergy may meet the criteria for possible ARFID but were missed by the EDY-Q.

A similar proportion of children with and without food allergy were identified by the EDY-Q of being at risk of ARFID. The EDY-Q may lack sensitivity to detect ARFID in individuals with food allergy as it does not capture fear of allergic reactions. Newer ARFID tools incorporating fear of allergic reactions have since become available. Future research using these tools may provide more precise prevalence estimates among individuals with food allergy.