Psychological needs and support among patients and families undergoing food oral immunotherapy

Abstract

Background Oral immunotherapy (OIT) is a promising treatment for food allergy (FA) however it is a challenging process for patients and parents. Induction can generate stress and anxiety. This may in turn affect their motivation and ability to cope with OIT challenges. Objective This study aimed to investigate psychological needs and support to patients/parents undergoing food OIT assessing participants' main characteristics, reasons for seeking psychological support, OIT phase and related psychological difficulties, type and timing of treatments and patients' perception of the effectiveness of the intervention. Methods This is an observational, retrospective study. 50 psychological interventions required for OIT related problems were selected consecutively in a Referral Centre in North‐Eastern Italy. All patients had a medical diagnosis of FA and were undergoing OIT or had just discontinued it. Data were collected from hospital records. A descriptive statistical analysis was performed. Results 66% of patients asked for psychological support for the initial phase (e.g., oral food challenge, first maintenance doses), 20% during the up‐dosing phase, 8% during maintenance and 6% after discontinuation. 70% of treatments were required mainly because of emotional problems including dysfunctional anxiety and mood disorders, increased distress and excessive worry and/or fear related to OIT; 20% because of difficulties in managing OIT; 10% because of eating difficulties; 50% of patients reported recent anaphylaxis. All patients reported improvement and felt the psychological intervention was helpful. Conclusion It is recommended to evaluate the psychological needs in profiling patients and families suitable to OIT and offer specific psychological support when needed.

Information needs of patients considering oral immunotherapy for food allergy

“…65 Early involvement of professional psychological input can be beneficial and is an option for families considering OIT. 66 While anxiety about doses and reactions may predominate, boredom and frustration with daily dosing and distaste for the food are common and can lead to daily household disagreements and emotional outbursts. Taste aversion may be related to an association with prior reactions, long-term avoidance strategies, oral itch and/or a natural self-protective response to avoid the allergen.…”

“…Families should anticipate such issues may arise before starting OIT, especially if the patient or family already has baseline anxiety 65 . Early involvement of professional psychological input can be beneficial and is an option for families considering OIT 66 . While anxiety about doses and reactions may predominate, boredom and frustration with daily dosing and distaste for the food are common and can lead to daily household disagreements and emotional outbursts.…”

Láthatatlan akadályok – súlyos gyermekkori ételallergia a családban

“…A különböző immunterápiák térnyerése újfajta kihívás elé állítja az ételallergiás családok ellátását. Az orális immunterápiák (OIT) alkalmazása hosszú távon növelheti ugyan az életminőséget, ám komoly pszichoszociális terhet is jelenthet a kezelés mellett elköteleződő családoknak [27,45]. Polloni és mtsai [45] tanulmányukban pszichológiai segítséget igénylő OIT-ben részt vevők, illetve a kezelést megszakítók jellemzőit tekintették át.…”

“…Az orális immunterápiák (OIT) alkalmazása hosszú távon növelheti ugyan az életminőséget, ám komoly pszichoszociális terhet is jelenthet a kezelés mellett elköteleződő családoknak [27,45]. Polloni és mtsai [45] tanulmányukban pszichológiai segítséget igénylő OIT-ben részt vevők, illetve a kezelést megszakítók jellemzőit tekintették át. Eredményeik alapján a résztvevők 66%-ának az OIT kezdeti szakaszában volt szüksége pszichológiai támogatásra, a kezelés igénylésének fő indoka pedig 70%-ban emocionális nehézségeknek (az OIT-vel kapcsolatos túlzott szorongás, félelem, hangulati problémák) volt a következménye.…”

Children and caregiver proxy quality of life from peanut oral immunotherapy trials

“… 25 Notably, providing psychological support to patients undergoing OIT and their families may improve HRQoL. 26 …”