Cognitive behavioral therapy helps food allergic children with severe phobia of anaphylaxis

Reviewed by Emily Henderson, B.Sc.Jul 28 2020

Imagine a young girl with a peanut allergy, so stricken by fear of anaphylaxis that she no longer takes part in everyday activities many children take for granted. She's stopped playing with her siblings, worried that residue from their peanut butter crackers may trigger an allergic reaction. She obsessively washes her hands to make sure there is no trace of peanut on them. She worries that every stomachache could mean she accidently ate something she was allergic to.

This story is becoming more familiar to families across the country. While most children with food allergies maintain a healthy level of caution, there is a small percentage whose anxiety is excessive and impairing. The hallmark of excessive anxiety is going to extreme, medically unnecessary lengths to avoid the allergen, such as no longer visiting extended family or refusing to eat any allergen-free food that isn't familiar. While these coping mechanisms may relieve anxiety in the short term, they may ultimately cause more harm by negatively reinforcing the idea that the world is a dangerous place and that children are helpless to keep themselves safe.

Now, Children's Hospital of Philadelphia (CHOP) has launched the Food Allergy Bravery (FAB) Clinic to help children with a phobia of anaphylaxis. This revolutionary clinic, housed within the Food Allergy Center, is the first in the world to bring together psychologists and food allergy experts to treat food allergic children with severe phobia of anaphylaxis.

The three Founders of the FAB Clinic published a set of best practices in the Journal of Allergy and Clinical Immunology, providing guidance to allergists and pediatricians on how to address allergy-related phobias through Cognitive Behavioral Therapy (CBT).

CBT works by gradually encouraging anxious children to take part in 'brave practices,' like eating with the rest of their family, playing with siblings, and trying new foods that don't contain allergens. As a child's confidence grows, we gradually introduce them to more challenging brave practices. This could include sitting in the same room with the food they're allergic to, or even touching the food and then washing their hands thoroughly. The aim is to help children realize, through safe, structured practices in the FAB Clinic, that the world is much safer than they think and that they are capable of keeping themselves safe within it."

Katherine Dahlsgaard, PhD, ABPP, Director of the FAB Clinic at CHOP

The FAB clinic enthusiastically employs the help of family members, coaching parents or caregivers to repeat brave practices at home.

"We want these children and their families to know they're safe and capable," said Dr. Dahlsgaard. "Our ultimate goal is to equip families with practical skills and confidence via focused treatment sessions, so that their child can safely navigate a world that can't always be allergen-free."