D2.299 - ARFID: The Hidden Face of Food Allergy?

Avoidant/Restrictive Food Intake Disorder (ARFID) may be under-recognized in children with food allergies, where elimination diets and fear of reactions can intensify restrictive eating. We aimed to compare ARFID symptom burden between children with and without food allergy and to explore clinical correlations among allergic children.

This cross-sectional study included 110 children.Food allergy status (yes/no) and number of food allergies (single vs multiple) were recorded.Children in the food allergy group were followed for IgE-mediated food allergy; those who developed tolerance and had at least 24 months elapsed since tolerance development were included in analyses involving ‘time to tolerance’.ARFID symptom burden was assessed using the Nine Item ARFID Screen(NIAS). In addition to the NIAS total score,the three NIAS subscales were analyzed: Picky Eating, Low Appetite/Low Interest in Eating, and Fear of Aversive Consequences. Group comparisons were performed using Mann–Whitney U tests.Categorical variables were analyzed with chi-square/Fisher’s exact tests.Spearman correlations examined associations of NIAS scores with eosinophil count, percentage, specific Ige, total IgE, and time tolerance.

This study included 110 children aged 3–10 years (mean 5.62±1.42). Food allergy was present in 60/110 (54.5%). Age did not differ between groups (p=0.285). Children with food allergy had significantly higher NIAS scores than non-allergic peers: NIAS Picky Eating (6.32±4.38 vs 3.12±4.37; p<0.001), NIAS Low Appetite/Low Interest (5.50±4.02 vs 2.58±3.86; p<0.001), NIAS Fear of Aversive Consequences (0.80±1.67 vs 0.00±0.00; p<0.001),and NIAS total (12.62±7.55 vs 5.70±8.08; p<0.001).Family atopy was more frequent in the food allergy group (56.7% vs 18.0%; p<0.001), and income level differed significantly (p<0.001). Among allergic children, 37/60 (61.7%) had single and 23/60 (38.3%) multiple food allergies;NIAS scores did not differ between single vs multiple allergy groups (all p>0.05). Absolute eosinophil count, eosinophil percentage, specific and Total IgE were not associated with NIAS scores. Time to tolerance correlated negatively with NIAS Picky Eating (ρ=-0.297, p=0.022) and NIAS total (ρ=-0.257, p=0.049).

 Children with food allergy exhibit a markedly higher ARFID symptom burden on NIAS, suggesting ARFID may represent a “hidden face” of food allergy. Routine screening with NIAS and attention to its subdomains may help identify at-risk children and guide multidisciplinary management.