Pediatric patients with medical/developmental conditions face increased risk for avoidant/restrictive food intake disorder (ARFID). Diet-managed chronic illnesses may heighten risk for disordered eating, with emerging research finding medical symptoms predating disordered eating behaviors. Pediatric-onset immunoglobulin E-mediated food allergy ("food allergy") is on the rise, affecting an astonishing 8% of US children. The relationship between food allergy and ARFID is puzzlingly understudied despite food allergy clearly altering the individual's relationship with food, posing continuous danger, and requiring persistent, fundamental eating changes to maintain safety. Food allergy is managed through strict dietary avoidance of allergen(s) and confers well-documented risk to psychosocial functioning. Dietary restriction exceeding medically required avoidance (as observed in ARFID) further compounds risk for adverse health and psychosocial impacts. In this Spotlight, our team of clinical researchers working at the intersection of ARFID and food allergy proposes a model identifying three areas of food allergy-specific impact that may drive the higher prevalence of ARFID within this population. Failure to successfully regulate these universal drivers to preserve daily functioning may precipitate the development of ARFID. We propose (1) unique characteristics of allergic reactions and medical treatment, (2) the impacts of chronic vigilance and avoidance, and (3) response to learning paradigms and physiological upregulation disrupt the development of feeding/eating for both patients and caregivers. Patients with food allergy + ARFID may also be especially vulnerable to iatrogenic harm from the imprecision of current allergy testing modalities. We outline the sparse literature on food allergy + ARFID comorbidity and call for ARFID-focused research in this area.
Keywords: avoidant/restrictive food intake disorder; food allergy; pediatrics.
© 2026 Wiley Periodicals LLC.