CHOP Researchers Develop Screening Tool to Measure Anxiety in Children with Food Allergies

Published on in CHOP News

Children with food allergies can develop excessive anxiety related to their condition, which can lead to medically unnecessary avoidance of social situations where food is present and a lower quality of life than they deserve. However, until now, there was no questionnaire available that could specifically assess anxiety in these children and their families. Instead, allergists and food allergy researchers had to rely on less precise questionnaires that were general measures of pediatric anxiety

To close that gap, researchers at Children’s Hospital of Philadelphia (CHOP) have developed a new scale specifically to measure food allergy related anxiety in children. The tool, called the Scale of Food Allergy Anxiety (SOFAA), was developed in partnership by medical professionals in CHOP’s Food Allergy Center and a cognitive-behavioral psychologist specializing in pediatric anxiety, in consultation with parents of children with food allergies.

In order to allow for the most complete and accurate assessment of a child’s anxiety, they developed two separate questionnaires: the SOFAA-C for children, and the SOFAA-P for parents or caregivers. The SOFAA-C is meant for children and adolescents ages 8 to 18 to assess food allergy-related anxiety and related anxious avoidance behaviors over the past week. For the SOFAA-P, parents rate their perceptions of their child’s food allergy-related anxiety and anxious avoidance over the past week.

Both versions consist of 21 items, presented in the same order and with similar wording. There are also condensed versions of the questionnaires for quicker screening. All versions of the SOFAA are scored on a 5-point rating scale, with 4 points for “Almost Always” and 0 points for “Never.” Ratings from all items are summed to create a Total Score. Higher scores indicate greater anxiety.

The researchers tested the validity and reliability of the new scale on 77 parent-child pairs. Both parents and their food-allergic children completed full versions of the SOFAA online. The research team found strong agreement between answers by children and their parents, and those who retook the survey at a later timepoint maintained similar scores, underscoring the reliability of the tool. The findings validating the SOFAA were published recently in The Journal of Allergy and Clinical Immunology: In Practice.

“We hope that with further validation and research, the SOFAA can be used to determine the prevalence of excessive anxiety in children with food allergies and provide guidance on managing that anxiety when flare-ups occur,” said study co-author Megan O. Lewis, MSN, CRNP, Program Manager of the Food Allergy Bravery Clinic at CHOP. “Researchers who study quality of life in children with food allergies now have a more precise tool at their disposal, as we have chosen to make the SOFAA free to use and easily accessible online.”

Learn more about our Food Allergy Bravery Clinic here.


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