The mental health impact of living with allergy

Professor Chrissie Jones is Professor of Clinical Health Psychology in the School of Psychology at the University of Surrey. Prof Jones’ main research focuses on the design and evaluation of psychological and behavioural interventions for individuals and their families, with long term conditions such as allergy, diabetes and respiratory disease plus mental health comorbidities. 

 

Allergic conditions, particularly food allergy, are often viewed primarily through a biomedical lens. However, for many patients and families the psychological burden can be as significant as the physical risks. Living with allergy involves constant vigilance, daily risk assessment and the ever-present possibility of a potentially life-threatening reaction. Increasing evidence highlights that this chronic uncertainty can have a substantial impact on mental health and quality of life across the lifespan. 

Primary care clinicians can play a vital role in recognising these impacts and supporting patients to manage both the physical and psychological aspects of allergy. 

Living with allergy: A constant state of vigilance 

Unlike many chronic conditions, food allergy management depends largely on the patient’s behaviour and environment rather than medication alone. The primary strategy remains strict allergen avoidance combined with readiness to treat reactions should they occur. International guidelines emphasise avoidance strategies, emergency treatment plans and the provision of adrenaline auto-injectors for those at risk of anaphylaxis.1 

However, implementing these strategies requires constant vigilance. Individuals with food hypersensitivity must continually assess risks when eating, socialising or travelling. For example, studies show that adults routinely check ingredients, question staff and evaluate food environments when eating out to avoid accidental exposure.2 This continuous risk assessment can be mentally exhausting and is a key driver of food allergy related anxiety. 

Psychological distress in allergy 

Research consistently demonstrates that people living with food allergy experience higher levels of psychological distress and poorer health-related quality of life than the general population. 

A large international survey of more than 2,700 adults and caregivers found that anxiety about experiencing an allergic reaction was the most commonly reported psychological difficulty, affecting over 60% of adults and more than 70% of caregivers.3Several factors appear to increase the risk of psychological distress, including: 

  • A history of severe reactions or anaphylaxis 
  • Being allergic to multiple foods 
  • Having an adrenaline auto-injector prescription 
  • Perceived severity of the allergy 
  • Caring for younger children with allergy. 

These factors influence not only perceived risk but also daily lifestyle restrictions and uncertainty about safety. 

Qualitative research exploring the experiences of adults with food allergy highlights how individuals often describe their condition as a “permanent struggle”, requiring ongoing planning, self-monitoring and adaptation to manage anxiety and maintaina sense of control.4  

Impact on families and caregivers 

The psychological impact of allergy is particularly significant for parents of allergic children. Parents must assume responsibility for preventing reactions while managing the constant possibility that exposure could occur outside their direct supervision. 

Studies show that food allergy can significantly affect caregiver quality of life, with anxiety, stress and feelings of isolation commonly reported.5  

Some parents describe feeling reluctant to allow others to care for their child due to fears about allergen exposure or inadequate understanding of allergy management. This can lead to increased parental burden and reduced opportunities for children to develop independence. 

Research also highlights the complex relationship between parental anxiety and children’s adjustment. High parental anxiety may lead to overly restrictive behaviours or avoidance of normal activities, potentially affecting a child’s social development and confidence. 

Adolescence and adherence challenges 

Adolescence is recognised as a particularly high-risk period for severe allergic reactions. At this stage, young people typically begin to assume responsibility for their own allergy management while navigating social environments where food sharing and eating out are common. 

Studies examining self-care behaviours in adolescents demonstrate that adherence to recommended management practices, such as allergen avoidance and carrying adrenaline auto-injectors, is often suboptimal.6  

Psychological factors play a significant role in these behaviours. Perceived severity of the allergy, beliefs about risk, and perceived barriers to management influence whether young people engage in protective behaviours. 

Support networks may also play an important role. Young people involved in allergy support groups report increased confidence, improved self-esteem and better adherence to self-care behaviours.7 

Experiences within healthcare 

Patients’ experiences of allergy testing and diagnosis can also influence psychological outcomes. For many individuals, diagnostic testing represents a period of uncertainty and anxiety while they await confirmation of a suspected allergy. 

Qualitative studies of both adults and parents highlight the importance of clear communication and information during testing procedures to reduce distress and misunderstandings.8-9 These findings reinforce the importance of supportive communication throughout the diagnostic pathway. 

Access to psychological support 

Despite the clear psychological burden associated with allergy, access to psychological support remains limited. 

Global research examining access to psychological services for individuals with food allergy found that while two-thirds of adults and over three-quarters of caregivers reported experiencing allergy-related psychological distress, fewer than 20% had ever been assessed for these difficulties.10Barriers to accessing support include cost, lack of available services and limited awareness among healthcare providers. 

Encouragingly, emerging research suggests that targeted psychological interventions may be effective. For example, online group-based interventions focusing on coping strategies and anxiety management have shown promising improvements in quality of life and worry among adults, children and parents living with food allergy.11 

What can healthcare professionals do? 

HCPs are often the first point of contact for patients living with allergy and are therefore well-placed to recognise and address the psychological impact of the condition. Practical steps include: 

  1. Normalising psychological responses
    Anxiety related to allergy risk is common and understandable. Acknowledging this can help patients feel validated and supported.
  2. Screening for distress
    Consider asking simple questions about worry, avoidance behaviours or the impact of allergy on daily life.
  3. Supporting self-management
    Clear written management plans, education about allergen avoidance and emergency treatment can improve confidence and adherence.
  4. Signposting support
    Patient organisations and peer support groups can provide valuable practical and emotional support.
  5. Considering psychological referral when needed
    Patients experiencing significant anxiety, avoidance behaviours or reduced quality of life may benefit from referral to psychological services.

Moving toward integrated allergy care 

There is increasing recognition that effective allergy care must address both physical and psychological needs. Integrated models which incorporate psychological support within allergy services have the potential to improve patient outcomes and quality of life. 

As awareness grows, healthcare professionals can play a key role in identifying psychological needs early and ensuring patients receive holistic support. Ultimately, supporting the mental health of people living with allergy is not an optional extra, it is an essential component of good clinical care. 

 

References 

1Santos AF, Riggioni C, Agache I, et al. EAACI guidelines on the management of IgE-mediated food allergy. Allergy. 2025;80(1):14-36. doi:10.1111/all.16345 

2Knibb RC, Hawkins L, Screti C, Gowland MH, Krishna MT, du Toit G, Jones CJ. Risk assessment behaviour when eating out in adults with food hypersensitivity. Clin Transl Allergy. 2024 Jan 31;14(2):e12336. doi: 10.1002/clt2.12336. 

3Purser SEM, Jones CJ, Protudjer JLP, Herbert LJ, Screti C, Roleston C, Mattacola E, Brough HA, Warren C, Polloni L, Santos AF, Gupta R, Marchisotto MJ, Knibb RC. Associations with food allergy-related psychological distress in a global sample of adults, children and caregivers. Clin Transl Allergy. 2025 Jun;15(6):e70071. doi: 10.1002/clt2.70071. 

4Roleston C, Protudjer JLP, Herbert LJ, et al. “It’s a Permanent Struggle to Manage It Really”: Psychological Burden and Coping Strategies of Adults Living With Food Allergy. Qual Health Res. Published online March 17, 2025. doi:10.1177/10497323251320839 

5Sugunasingha N, Jones FW, Jones CJ. Interventions for caregivers of children with food allergy: A systematic review. Pediatr Allergy Immunol. 2020;31(7):805-812. doi:10.1111/pai.13255 

6Jones CJ, Llewellyn CD, Frew AJ, Du Toit G, Mukhopadhyay S, Smith H. Factors associated with good adherence to self-care behaviours amongst adolescents with food allergy. Pediatr Allergy Immunol. 2015;26(2):111-118. doi:10.1111/pai.12333 

7Jones CJ, Sommereux LA, Smith HE. Exploring what motivates and sustains support group engagement amongst young people with allergies: A qualitative study. Clin Exp Allergy. 2018;48(9):1195-1205. doi:10.1111/cea.13193 

8Smith H, Brown C, Robertson A, Stuttaford L, Rashid R, Jones CJ (2019) The Experience of Being Tested for Allergies; the Views of Children and their Parents. J Allergy Ther 10:1. 

9Brown CE, Jones CJ, Stuttaford L, Robertson A, Rashid RS, Smith HE. A qualitative study of the allergy testing experiences, views and preferences of adult patients. Clin Transl Allergy. 2016;6(1):34. doi:10.1186/s13601-016-0125-8 

10Knibb RC, Herbert LJ, Jones CJ, et al. Global availability and uptake of psychological services for adults, caregivers and children with food allergy. Allergy. 2024;79(10):2787-2797. doi:10.1111/all.16204 

11Jones CJ, Tallentire H, Edgecumbe R, Sherlock G, Hale L. Online, group, low-intensity psychological intervention for adults, children, and parents with food allergy. Ann Allergy Asthma Immunol. 2024;133(4):453-461. doi:10.1016/j.anai.2024.07.025