CHOP’s Food Allergy Bravery Clinic Helps Children

Philadelphia, September 28, 2022—From an early age, children with life-threatening food allergies are taught to be on the safe side: check labels, ask about ingredients, don’t eat anything at a friend’s house if you don’t know what’s in it contains. In some cases, however, necessary caution turns into unnecessary avoidance – not only of food but also of social situations where food might be served. This type of eating and avoidance disorder is driven by anxiety which, if left untreated, can significantly impair a child’s quality of life and social development.

Now a new study in the Annals of Allergy, Asthma and Immunology shows that a first-of-its-kind program at Children’s Hospital of Philadelphia (CHOP) can help children with food allergy anxiety reduce their fears and improve their quality of life. CHOP’s Food Allergy Bravery (FAB) program provides cognitive behavioral therapy (CBT) in five to eight sessions for children with severe anxiety related to their food allergies.

“For children with food allergies, a little anxiety is helpful in staying alert, but too much anxiety can prevent them from participating in safe and fun activities that are important for their development and quality of life,” said Megan O. Lewis, MSN, CRNP, co-director of the Food Allergy Bravery Clinic at Children’s Hospital of Philadelphia and co-author of the study. “This study shows that our Food Allergy Bravery program is an effective treatment for helping children with food allergy anxiety overcome their fears and improve their daily lives.”

The FAB Clinic was launched in 2018 as a collaborative project to address food allergy anxiety. Clinic leaders have developed a new screening tool to measure food allergy anxiety and a treatment manual for patients to address this anxiety and the related fear of anaphylaxis. Today, all patients seen with food allergies at CHOP are screened for anxiety and referred to the FAB clinic as needed.

Over the course of five to eight sessions, patients in the program receive individualized cognitive-behavioral treatment that includes repeated “courageous practices” to encourage the child to take small steps to face allergen-related fears and build confidence around food and social situations. Each session typically lasts 30-45 minutes and can be led by an allergist or mental health professional. In each session, patients perform a variety of bravery challenges that involve tasks like sniffing an allergen, touching an allergen (followed by hand washing), or eating an unnecessarily dreaded allergen-free food, followed by homework that involves perform these tasks at home. Exposures occur gradually, allowing patients to feel progressively closer to their allergen without having an allergic reaction.

The study, led by psychologist and former co-director of the FAB Clinic Katherine K. Dahlsgaard, PhD, evaluated the effectiveness of the FAB program by following 10 patients referred by their allergists specifically for the evaluation and treatment of allergy. anxiety related to food allergies. Although the FAB clinic is accessible to children and adolescents of all ages, the children included in the study were between 8 and 12 years old. All patients in the study had well-controlled confirmed IgE-mediated food allergies, as well as medically unnecessary and disabling anxiety and anxious avoidance related specifically to their food allergy.

Although current FAB Clinic sessions are conducted virtually and one-to-one, the paper analyzed pre-pandemic participants who had enrolled in a group format, in which children and their caregivers attended six 90-day sessions together. minutes.

The study found that after six sessions of the FAB program, patients showed significant reductions on two standardized anxiety scales: one that measures food allergy-specific anxiety (SOFAA), created at CHOP; and one that measures general anxiety (SCARED). Improvements were seen on the child-rated and parent-rated forms. Caregivers also completed satisfaction surveys at the end of treatment, and results showed that 100% of caregivers found the FAB program to be “very helpful” or “extremely helpful” for their children and for themselves. Children and parents also reported improved quality of life.

“A big part of the FAB program is education, both for patients and families — informing them of practices that are ‘safe enough,'” Lewis said. “Not only has this helped our patients to participate in more social events, but it has also made them more comfortable participating in important experiences related to allergy treatment, such as food allergy testing, dietary challenges and oral immunotherapy, which they couldn’t do. before enrolling in the FAB program.

Dahlsgaard et al. “Cognitive-behavioral intervention for anxiety associated with food allergy in a clinical sample of children”, Annals of Allergy, Asthma and Immunologyonline September 23, 2022, DOI: 10.1016/j.anai.2022.09.021


About Children’s Hospital of Philadelphia: A non-profit charitable organization, Children’s Hospital of Philadelphia was founded in 1855 as the nation’s first pediatric hospital. Through its longstanding commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals, and launching major research initiatives, the 595-bed hospital has fostered many discoveries that have benefited children all over the world. Its pediatric research program is one of the largest in the country. The facility has a well-established history of delivering advanced pediatric care close to home through its CHOP Care Networkwhich includes more than 50 primary care practices, specialty and surgical care centers, urgent care centers and community hospital alliances across Pennsylvania and New Jersey, as well as a new inpatient hospital with a dedicated pediatric emergency department at King of Prussia. In addition, its unique family-centered care and public service programs have earned The Children’s Hospital of Philadelphia recognition as a leading advocate for children and adolescents. For more information, visit

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