Mindset in food immunotherapy.

Abstract

Background: Mindset-the attitudes, beliefs and expectations an individual holds-plays a critical yet often underappreciated role in managing food allergies, particularly in the context of oral immunotherapy (OIT). Emotional states such as stress and anxiety can amplify allergic responses and shape how patients experience OIT, influencing adherence and perceived risk.

Evidence: Experimental studies from behavioural conditioning, neuroimmunology and placebo research demonstrate that psychological factors can modulate immune function, even in the absence of allergens. These effects are mediated through learned associations and expectation-driven physiological responses. Symptom framing also exerts measurable influence on emotional responses. Presenting mild OIT symptoms as 'positive signals' rather than 'side effects' has been shown to improve retention and adherence. The Preparing Patients for Oral Immunotherapy (PPOINT) expert consensus guidelines highlight the importance of recognising both patient and parent mindsets in education and clinical practice. This approach acknowledges the mental challenges inherent in OIT and helps to empower patients and their families in navigating them. Age and developmental stage strongly influence outcomes. Younger children more frequently achieve higher adherence, desensitisation and remission, while older children and adolescents are more prone to anxiety and taste aversion. Parental anxiety can further amplify these psychological barriers. Supportive psychosocial interventions, such as the involvement of medical clowns, have been shown to reduce stress and improve quality of life in children undergoing OIT. Underlying mechanisms offer a biological explanation for these findings. Stress-induced gut barrier dysfunction and expectation-driven placebo effects provide pathways through which mindset can modulate OIT responses. Emerging data also suggest that immune sensing of allergens can directly shape behaviour, driving avoidance even in the absence of anaphylaxis.

Clinical implications: Integrating mindset, emotional regulation and communication strategies into OIT protocols may reduce adverse events, enhance adherence and optimise immunological outcomes. Positive framing, psychosocial support and attention to patient and caregiver anxiety are effective strategies to enhance patient experience and treatment outcomes.

Conclusion: Mindset is a modifiable factor with direct behavioural and immunological consequences during OIT. Recognising and addressing psychological dimensions alongside clinical protocols can enhance safety, adherence and long-term outcomes, advocating for broader application of behavioural science in allergy management.