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Scale of Food Allergy Anxiety (SOFAA)

Scale of Food Allergy Anxiety (SOFAA)

Access and use of SOFAA

The Scale of Food Allergy Anxiety (SOFAA) is intended to screen children and adults at risk for excessive food allergy-related anxiety. The SOFAA can guide behavioral health interventions, aid mental health providers in the efficient construction of exposure hierarchies, and help to establish severity thresholds for eligibility and outcomes in a clinical trial.

All versions of the SOFAA are available below as downloadable PDFs. You may download and reprint a single copy of the SOFAA for personal or educational purposes provided you include all applicable notices and disclaimers.

By downloading the SOFAA, you agree to the Terms of Use. In addition, you acknowledge understanding that the SOFAA is not intended as medical advice or treatment and does not create a doctor-patient relationship between any individual and CHOP, and that any use of or reliance on the SOFAA is done so at your own risk. Any other use of any version of the SOFAA, including clinical, commercial and industry-sponsored research, is strictly prohibited without prior written permission or an appropriate license from CHOP.

To inquire about licensing, please contact licensing@chop.edu.

SOFAA versions

  • SOFAA-C is a self-rated questionnaire intended for use with children and adolescents aged 8 to 18 assessing food allergy-related anxiety and other related anxious avoidance behaviors over the past week.
  • SOFAA-P is a corresponding version of the scale in which parents rate their perceptions of their child’s food allergy-related anxiety and anxious avoidance over the past week.
  • SOFAA-A is a self-rated questionnaire intended for use with adults aged 18 and older. 
    • We recommend using the SOFAA-C for 18-year-olds that still live at home and the SOFAA-A for 18-year-olds that are out of the home, at college or in the workforce.
  • SOFAA-Jr Young Child is a caregiver-administered questionnaire intended for use with younger children aged 5 to 7. 
  • SOFAA-Jr Parent is a corresponding version of the scale in which parents of younger children aged 5 to 7 rate their perceptions of their child’s food allergy-related anxiety and anxious avoidance over the past week. 

Measure details

Full versions of both the SOFAA-C and SOFAA-P consist of 21 items, presented in the same order and with similar wording. Condensed versions of the measures are also available as the SOFAA-C-brief (14 items) and the SOFAA-P-brief (7 items).

The 21-item SOFAA-A is nearly identical to the SOFAA-C but includes minor wording changes to make it more relevant to adults. 

The 21-item SOFAA-Jr Young Child is nearly identical to the SOFAA-C but includes minor wording changes to reflect that it should be administered to a young child by their caregiver.

The 21-item SOFAA-Jr Parent is nearly identical to the SOFAA-P but includes minor wording changes to make it more relevant to parents.

In a validation study, the 21-item SOFAA-C and SOFAA-P showed good-to-excellent validity – evaluated for construct, as well as convergent and divergent effects – and excellent reliability, both for internal consistency and under test-retest conditions. 

As shorter screening measures, the 14-item SOFAA-C-brief and 7-item SOFAA-P-brief were also shown to be valid and reliable (see Dahlsgaard et al., 2021).

Frequently asked questions

How do I score the SOFAA measures?

For all versions of the SOFAA, responses are scored on a five-point rating scale.

  • 4 = Almost Always
  • 3 = Often
  • 2 = Sometimes
  • 1 = Almost Never
  • 0 = Never 

Ratings from all items create a Total Score. Report this raw total as “SOFAA-P Total Score was…” or “SOFAA-C Total Score was…”

Higher scores indicate greater anxiety.

Do I have to convert or recode the zero to 4 Likert scale to a 1 to 5 scale prior to scoring?

No. Use zero to 4 with no conversion.

What are the possible score ranges on the SOFAAs?

Total scores on the full, 21-item versions of the SOFAA-C, SOFAA-P, SOFAA-Jr Young Child, SOFAA-Jr Parent, and SOFAA-A range from a possible zero to 84. In the original validation sample (Dahlsgaard et al., 2021), the SOFAA-C Total Score mean was 29.1 (SD=18.3) and the SOFAA-P Total Score mean was 33.9 (SD=16.1).

Total Scores on the 14-item SOFAA-C-brief range from a possible zero to 56; Total Scores on the 7-item SOFAA-P-brief range from zero to 28. In the original validation sample (Dahlsgaard et al., 2021), the SOFAA-C-brief Total Score mean was 22.5 (SD=13.3) and the SOFAA-P-brief Total Score mean was 10.1 (SD=6.8). 

How do I handle missing items?

Calculate the mean item score from the completed items on an individual’s SOFAA and then impute that mean item score for any items that were not completed. Then, sum all items for a raw total score as described above.

How do I reference the original validation of the SOFAAs for a journal article?

The current reference for the SOFAA in Vancouver style is as follows:

Dahlsgaard KK, Wilkey LK, Stites SD, Lewis MO, Spergel JM. Development of the Child- and Parent-Rated Scales of Food Allergy Anxiety (SOFAA). The Journal of Allergy and Clinical Immunology: In Practice. 2022 Jan 1;10(1):161-169.e6.

The current reference for the SOFAA in APA style is as follows:

Dahlsgaard, K. K., Wilkey, L. K., Stites, S. D., Lewis, M. O., & Spergel, J. M. (2022). Development of the Child- and Parent-Rated Scales of Food Allergy Anxiety (SOFAA). The Journal of Allergy and Clinical Immunology: In Practice, 10(1), 161-169.e6.

Here is the online version of the article at JACI: In Practice.

Is there an electronic version of the SOFAAs with automatic scoring available?

At present, no. Please print out the SOFAAs and check back here for updates.

Are there any subscales or established cut points for the SOFAAs?

At present, no. Please report Total Scores and check back here for updates.

I would like information on obtaining a license to use the SOFAA outside of non-commercial research. Who do I contact?

Please contact the Office of Technology Transfer at The Children’s Hospital of Philadelphia via email at licensing@chop.edu.

I have more questions on the use of the SOFAA for non-commercial uses, or I would like to collaborate on research on further validation of the SOFAA. Who do I contact?

Please contact Megan O. Lewis, MSN, RN, CRNP, co-director of The Food Allergy Bravery Clinic within the Food Allergy Center at the Children’s Hospital of Philadelphia.