Food aversion and anxiety represent primary patient barriers to food oral immunotherapy

Background While oral immunotherapy (OIT) for food allergy is a reasonable treatment option, barriers to this procedure’s implementation have not been extensively evaluated from a patient perspective Objective We evaluated the barriers patients face during OIT administration, including anxiety and taste aversion, and evaluated the role of healthcare professionals, especially dietitians Methods A survey in Canada and the US involved families currently enrolled in food OIT programmes Results Of responses from 379 participants, fear of reaction was the most common barrier to OIT initiation, with 45.6% reporting it being a “very significant” barrier with other fears reported. However, taste aversion represented the prominent obstacle to continuation. Taste aversion was associated with slower buildup (p=0.02), and reduction in dose (p=0.002). Taste aversion was a strongly age-dependent barrier for initiation (p<0.001) and continuation (p<0.002), with older children over 6 years of age reporting it as a very significant barrier (p<0.001). Boredom was reported as a concern for specific allergens such as peanut, egg, sesame, and hazelnuts (p<0.05), emphasizing the need for diverse food options. Notably, 59.9% of respondents mixed OIT foods with sweet items. Despite these dietary concerns, dietitians were underutilized, with only 9.5% of respondents having seen a dietitian and the majority finding dietitian support helpful with greater certainty about the exact dose (p<0.001) Conclusions Taste aversion and anxiety represent primary patient-related barriers to OIT. Taste aversion was highly age-dependent, with older patients being more affected. Dietitians and psychology support were underutilized, representing a critical target to improve adherence and OIT success