If you or someone you know has a food allergy, then you understand the anxiety that can accompany meal and snack times. A certain level of apprehension is, of course, understandable, considering that some food allergies can cause severe or even life-threatening reactions. But while a degree of concern and advanced planning is undoubtedly warranted when it comes to food allergies, intense fear and rigid rules around food can, in some instances, contribute to the development of avoidant restrictive food intake disorder (ARFID).

People with ARFID typically struggle to eat because of extreme sensory sensitivities, fear of a bad outcome from eating, or lack of interest in food (as opposed to other types of eating disorders, in which disordered behaviors are driven by concerns around the body and weight). People with ARFID usually eat very little food, very few types of food, or both, but it’s much more than just extreme picky eating. It’s a psychological illness with serious mental and physical health consequences, and it affects people of all ages, races, genders, and body sizes.

Like all eating disorders, ARFID doesn’t have a single cause, but it can be helpful to understand potential contributing factors, including food allergies. Here’s what experts know about the connection between food allergies and ARFID.

How common are food allergies in people with ARFID (and vice versa)?

Overall, food allergies are quite common: in fact, almost 6% of adults and children in the U.S. have one. While food allergies are most common in babies and kids, they can develop at any age. The prevalence of ARFID is still largely unknown, but it’s most common in children (although adults can develop it as well), affecting approximately 3.2% of children and between 14-22.5% of children being treated for eating disorders. While prevalence estimates vary widely, there does appear to be a strong connection between food allergies and ARFID.

“Research shows that there is likely a very high overlap between ARFID and food allergies,” says Equip’s VP of Program Development, Jessie Menzel. “Two studies—one with children and one with adults— found extremely high rates of ARFID symptoms—over two thirds!—among those with food allergies. In ARFID samples, rates are lower but still significant.”

Why might some people with food allergies develop symptoms of ARFID?

As mentioned above, people with ARFID don’t restrict their food intake out of a desire to lose weight or change their body. Rather, they typically restrict the types of amount of food they eat for one of three reasons:

1. Sensory sensitivities (issues with taste, texture, smell, etc.)
2. Lack of interest in food
3. Fear of something bad happening if they eat (choking, vomiting, contamination, etc.)

For people with food allergies and ARFID, it’s typically reason #3. “ARFID is a very diverse eating disorder and food allergies are most commonly associated with the fear of aversive consequences, meaning that they usually cause someone to avoid food or restrict their eating due to fear of bad outcomes,” Menzel says.

ARFID doesn’t have one specific cause, but experts do believe that in some cases, food allergies may play a strong role in influencing the development of the eating disorder. “We think that food allergies place someone at higher risk for developing ARFID because of the necessary changes a person has to make to their diet to avoid allergic reactions,” Menzel says. “People with food allergies have to follow restricted diets and have had previous bad—even traumatizing—experiences with food. They are taught that they need to avoid certain foods for their own safety.”

While this behavior is often necessary for people with food allergies, this learned behavior can create negative associations with food. Over time, these feelings can develop into an increased caution or distrust of food in general.

“If that wariness becomes too extreme, people may start avoiding foods even though they’re safe simply due to the chance that it might be contaminated by an allergen,” Menzel says. “Sometimes these fears become so intense that people start to develop extreme fears, like fear of breathing air that might be contaminated by food allergens. When fears start to cross the line from reasonable to extreme and cause someone to avoid foods even though they’re safe, that’s when you’re dealing with ARFID.”

Can you prevent ARFID in people with food allergies?

Anyone with food allergies, or anyone who parents a child with food allergies, is familiar with the inherent obstacles in navigating meal and snack options. “Food allergies present many challenges for individuals and parents because it is necessary to exercise a certain amount of caution around food,” Menzel says. “Food actually can be dangerous for a person with food allergies.”

While there’s certainly some amount of caution and preparation that is required when living with a food allergy or parenting a child with one (or more), there are strategies for reducing the amount of anxiety or fear that may result from food monitoring. For parents in particular, Menzel recommends being mindful of two things:

1. How you express your own anxiety around your child’s food allergies. The most important way parents can demonstrate a reasonable amount of ease around food is to model sensibly cautious but calm behavior. “As a parent, it’s important to show confidence to your child,” Menzel says. “They will pick up on cues from you. Take only the absolutely necessary steps to ensure that food is safe and resist the temptation to do more.”
2. The lengths you go to reassure your child that food is safe. “Going to great lengths to assure your child that a food is safe can quickly become a slippery slope,” Menzel says. “Even though it might make your child feel better in the short term, this behavior can actually increase your child’s fears over time. Before you know it, your child will begin to question or fear even safe foods, a hallmark of ARFID in kids with food allergies.”

If you’re an adult living with food allergies and are worried that you’re developing rigid or extreme behaviors that might lead to ARFID, your best bet is to talk to a professional. With the right support, you can develop tactics for safely managing your allergy without slipping into an eating disorder.

Are certain food allergies more likely than others to lead to ARFID?

Any food can cause an adverse reaction in someone who is allergic to it, but there are eight foods or food groups that account for most serious allergic reactions in the U.S.:

1. Milk
2. Eggs
3. Wheat
4. Fish
5. Soy
6. Crustacean shellfish
7. Peanuts
8. Tree nuts

That being said, there is no reason to assume any one of these foods or food groups is more likely to lead to ARFID than any others.

“There isn’t a lot of data linking specific types of allergies to increased risk of developing ARFID,” Menzel says. “But ARFID has been associated with IgE-mediated food allergies and eosinophilic esophagitis (EOE)—but it likely can occur with any type of food allergy.”

Otherwise known as Immunoglobulin E, IgE are antibodies produced by the immune system in response to an allergen. These antibodies are what are responsible for allergic reactions. Someone with IgE-mediated food allergies experiences an abnormal immune response when exposed to certain foods, such as milk, eggs, wheat, nuts, and more. Certain food allergies can contribute to EoE, an inflammation of the esophagus, but researchers are still unclear on which specific foods could be the cause.

“Research is very clear, though, that anytime someone is asked to follow an exclusion diet—a common recommendation when a food allergy or sensitivity is suspected—risk for developing ARFID is substantially increased,” Menzel says.

What to do about food allergies and ARFID

Knowing that food allergies may increase the chances of developing ARFID can empower you to be on the lookout for telltale signs and symptoms, whether it’s in yourself or your child. In addition to behavioral changes like food restriction or limitation, ARFID can also show up in physical symptoms, including significant weight loss, abdominal pain, constipation, and more.

“The presentation of ARFID that food allergies are associated with is the one that is most likely to result in rapid, significant weight loss, which can lead to hospitalization,” Menzel says. “Therefore, it is extremely important to be on the alert for signs of ARFID development.”

While food allergies may require lifelong monitoring and treatment, ARFID is an eating disorder that can be effectively treated with the support of a multidisciplinary team of experienced clinicians. “The good news is that ARFID in the context of food allergies is very treatable!” Menzel says. “If you’re concerned about ARFID and food allergies, speak to a mental health professional who specializes in anxiety or eating disorders for help.”