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Social Anxiety May Influence Safety Behaviors in Teens With Food Allergy, With Melissa Engel, PhD
Engel discusses ADAA 2026 findings identifying fear of social judgment as a distinct component of food allergy–related anxiety in adolescents.
Adolescents with food allergy may experience anxiety driven not only by fear of allergic reactions but also by concern about social judgment, according to findings presented at ADAA 2026. In an interview with HCPLive, Melissa Engel, PhD, a postdoctoral fellow at Feinberg School of Medicine at Northwestern Medicine, highlighted food allergy–related social anxiety as a distinct construct that may influence both psychosocial outcomes and safety-related behaviors.
“I am really excited about this research, because to date, most of the attention in both literature and in clinical context, in terms of anxiety and food allergies [in adolescents], is really focused on the fear of having an allergic reaction…nd this construct of social anxiety is getting more at the fear of…judgment from others [and]...standing out. That is something that I see clinically all the time, yet [it] is just not really received any attention, and that would require treatment that is different than treatment for fear of having an allergic reaction.”
The study surveyed 219 adolescents (mean age, 15.89 years) using a self-report questionnaire assessing anxiety across 12 common social activities. Participants rated both fear of allergic reaction and fear of negative social evaluation using a 5-point Likert scale.
Substantial proportions of adolescents reported both types of anxiety. Across activities, 43.9% to 78.1% reported fear of allergic reaction, while 25.8% to 58.7% reported fear of negative social evaluation at similar levels. The 2 domains were moderately correlated overall, though agreement varied by context.
Fear of allergic reaction was highest in travel, restaurants with friends, and birthday parties. In contrast, fear of negative social evaluation was most prominent in birthday parties, dating, and school activities involving food. Engel noted that these differences underscore the importance of considering context when assessing adolescents with food allergy.
Engel explained that fear of allergic reaction often resembles a specific phobia, characterized by avoidance of allergens and concern about accidental exposure. Food allergy–related social anxiety, however, centers on embarrassment, reluctance to disclose allergies, and concern about being perceived as burdensome. This can lead teens to avoid social situations where their allergens are present.
Adolescence may be a particularly vulnerable period, given the importance of peer relationships and increasing independence. Engel added that social concerns may contribute to specific behaviors that could affect anaphylaxis preparedness, including choosing not to carry epinephrine to avoid drawing attention, avoiding disclosure of food allergies at restaurants or social events, declining to ask about ingredients, or hesitating to advocate for safe accommodations.
“If they're worried about judgment from their peers, it might make them more likely to take risks that aren't so safe,” she said.
The findings suggest clinicians may benefit from broadening screening beyond the fear of allergic reaction. Existing tools, such as the Scale of Food Allergy Anxiety, primarily assess fear of anaphylaxis, while validated measures for food allergy–related social anxiety are not yet available.
Engel recommends incorporating open-ended questions into clinical visits, including how food allergies affect social life or whether adolescents avoid certain situations. These discussions may help differentiate between safety-related fears and concerns about social perception.
Engel also emphasized individualized assessment, as adolescents encounter different social environments, including restaurants, sleepovers, sports, and dating. Understanding context-specific concerns may help guide counseling and behavioral strategies.
Future research will focus on developing validated screening measures and adapting cognitive behavioral interventions for food allergy–related social anxiety. Engel suggested modifying existing social anxiety treatments to include practicing disclosure of food allergies and self-advocacy in real-world settings.
“This is preliminary data,” Engel said, “[but it] hasn't really been looked at before.”
A relevant disclosure for Engel includes Mallinckrodt Hospital Products Inc.
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