Using adrenaline auto-injectors (AAI), difficulties in choosing allergen-free foods, lack of understanding in peers and others, and fear of stigmatisation were among the main concerns voiced by adolescents with food allergies, a systematic review has found.

The study authors carried out a literature search to identify peer‐reviewed articles that analysed the beliefs of adolescents aged 11-19 years about their food allergy.

Overall, 20 papers met the inclusion criteria, four used quantitative methods (questionnaires) and 16 qualitative methods (mainly interviews and focus groups). All included studies were published between 2007 and 2020; 11 were conducted in the UK, six in other European countries and three in Canada.

Five themes were identified:

• Navigating food allergy in different environments

• Carriage and use of adrenaline auto‐injectors

• Managing the risk of anaphylaxis

• Behaviour and understanding of others

• Food‐allergic identity

Navigating food allergy in different environments

Adolescents worried about the expertise of catering staff when eating out and asking about allergens was felt to be embarrassing. They were reluctant to try new foods in unfamiliar environments.

Some young people reported bullying at school and having food containing allergens thrown at them. Special treatment was not thought to be the answer because it might highlight them as different.

Carriage and use of adrenaline auto‐injectors

Barriers such as being seen as different or AAI carriage being inconvenient resulted in lower adherence to AAI carriage.

Boys were less likely to carry one than girls. More boys felt the device was too large to be carried in a pocket.

Difficulty of use was also a barrier to carriage. Many young people were worried about using their device correctly, some had a fear of needles.

Managing the risk of anaphylaxis

Adolescents who viewed their food allergy as unstable, unpredictable and episodic were less likely to be adherent to self‐care behaviours.

Some adolescents were dismissive towards high‐risk behaviours that may potentially result in anaphylaxis and others expressed a great fear of allergic reactions.

Sometimes potential allergens would be eaten to ‘fit in’ to social groups.

A common risky behaviour was dismissal of ‘may contain’ labels.

Behaviour and understanding of others

Participants felt that peers tended to focus on the limitations of their food allergy identifying them as ‘different’.

Many thought being able to talk with others of the same age who had similar problems was helpful.

Better education and awareness about food allergies particularly in peers, teachers and catering staff was also important.

Food‐allergic identity

Although some adolescents believed food allergy was a large part of their identity, others grew accustomed to having an allergy but felt is should not define them.

There was a desire for an increase in normalisation of food allergy. Some individuals did not disclose their food allergy to avoid exclusion.

The study authors conclude that greater understanding from healthcare professionals about the importance of beliefs and how they relate to behaviour is essential.

They say: ‘Regular training and support from clinics may improve protective behaviours such as carriage and use of AAI, and checking of food labels, though it is important to address beliefs developed from fear or misinformation.’

Understanding the health beliefs of our patients is often the key to better outcomes. This study provides an important insight into why adolescents are most at risk from serious food allergy reactions.

Dr Peter Saul