EXCESSIVE anxiety surrounding food allergies is common and can significantly impact a patient’s quality of life. While allergists often focus on physical safety and avoidance strategies, many patients engage in medically unnecessary avoidance due to fear, even when the actual risk of anaphylaxis is low. Such avoidance may reinforce anxiety, limiting social activities and causing undue stress.
Recent evidence supports the use of proximity challenges, carefully controlled exposure to allergens that are extremely unlikely to cause a reaction, as an effective way to address this issue. These challenges align with cognitive-behavioural therapy (CBT) principles, particularly exposure therapy, which is considered the most effective treatment for anxiety disorders.
By gradually introducing patients to the idea of touching or being near their allergen (without ingesting it), clinicians can help disprove catastrophic beliefs such as “touching my allergen will cause anaphylaxis.” This type of hypothesis testing, rather than reassurance or avoidance, forms the cornerstone of exposure-based therapy. Importantly, the aim is not immediate reduction of anxiety, but learning through experience that feared outcomes do not occur.
A typical session might include several exposure exercises, such as sniffing or touching a food allergen, followed by discussion of what was learned. Clinicians are advised to avoid over-reassurance, which can undermine the exposure’s effectiveness, and instead encourage patients to function despite feeling anxious.
Varying the exposures, such as using different forms of the allergen or combining allergens, deepens learning and helps prevent relapse. Short, clear explanations of allergen biology help counter misinformation (e.g., “proteins do not pass through unbroken skin”) but should be followed by action, not extended discussion.
For best results, allergists should screen for anxiety, educate patients about proximity challenges, and consider incorporating these techniques into regular care. While more research is needed, early evidence suggests that exposure-based interventions can reduce food allergy anxiety and improve patients’ quality of life, making them an important part of holistic allergy management.
Reference
Dahlsgaard KK, Lewis MO. Want to help your patients with food allergy anxiety? Do proximity challenges!. Ann Allergy Asthma Immunol. 2025;134(5):525-32. doi:10.1016/j.anai.2025.02.020
