What Research Data Says About Food Allergy Anxiety

One of the most common reasons people reach out to allergy-informed therapy providers is for help managing food allergy anxiety. It's easy to understand why allergic individuals and families may feel anxious, but it's also useful to learn more about food allergy anxiety itself - the data and insights behind the emotion. 
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 What Have We Learned About
​Food Allergy Anxiety So Far?

Therefore, this Food Allergy Counselor post offers an overview of key points from a 2020 research article entitled, "Anxiety and Food Allergy: A Review of the Last Two Decades". As the research article is 22 pages long with lots of data, this serves as a highlight of key information. 

Anxiety Basics: 

• Anxiety is often triggered by unpredictability, uncertainty, unknowns, new experiences, and change/transition.
  
  
• Experiencing anxiety or anxious feelings is not the same as being diagnosed with an anxiety disorder, which requires meeting a specific set of criteria. 
  
  
• Symptoms of anxiety typically include thoughts of future-focused worry and apprehension, as well as physical sensations such as rapid heartrate, sweating, and nausea, especially if in the presence of perceived or actual danger (i.e. fight, flight or freeze response).
  
  
• Anxiety symptoms can be short-lived and situation-specific, or ongoing and over-generalized.
  
  
• At lower levels, anxiety can be useful, motivating us to prepare and make safe choices. Higher levels of anxiety, especially if ongoing in nature, tend to lead to unhelpful actions, distress, and interference in daily functioning. 
  
  
• Anxiety disorders are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health.

Food Allergy Anxiety (FAA):

• A predominant theme that came to light in this article was anxiety that results from the experience of the first severe reaction.
  
  
• FAA tends to be focused on specific fears and/or FA-related phobias, and is often related to (or as a result of) specific events.
  
  
• Similar to general anxiety, lower levels and short-lived FAA can actually help us be appropriately cautious, whereas higher levels and ongoing FAA tend to lead to life-impacting avoidance and distress.
  
  
• High levels of FAA around the time of diagnosis can motivate us to gather information that leads us to effectively manage the FA, which also helps decrease FAA. With time and practice, FAA levels tend to stabilize.
  
  
• (3) key events typically trigger increased/renewed FAA: New accidental exposures, new information about potential risks, and developmental transitions leading to increased threats of risk. These triggers can motivate some to make improvements in their FA management approaches.
  
  
• Those experiencing ongoing and high levels of FAA may perceive allergen risks to be more elevated than they truly are, which can lead to over-avoidant and life-limiting behaviors.
  
  
• Heightened allergen risk perception is associated with higher levels of anxiety.

FAA and Oral Immunotherapy (OIT) / Oral Food Challenges (OFC):

• After an OFC, study data showed that mothers experienced a reduction in FA parental burden, but not in general stress and anxiety levels.
  
  
• Research shows OIT has a general positive effect on some aspects of quality of life, particularly relating to food anxiety, and social and dietary limitations, but not the emotional impact. 
  
  
• A recent study showed that quality of life improves significantly with OIT, including emotional impact and food anxiety upon reaching OIT maintenance, and with additional improvement 6 months later.

FAA and Parents/Families:

• Anxiety and fear are parental instincts that intensify when their child has been diagnosed with a FA.
  
  
• It's not uncommon for parents to feel anxious when introducing new foods to their allergic child and younger siblings.
  
  
• Differences in parental FAA may be reflective of anxiety fluctuations in different stages on the FA journey and/or the child's development, as well as differentiations in families’ adaptation and resilience.
  
  
• Research has led to the development of patterns relating to how families adapt to FA that are based on levels of anxiety, balanced psychosocial functioning, and effectiveness of FA management. This can help practitioners understand the direction of therapeutic goals for each allergic family. 
  
  
• Cultural aspects, personalities, and previous trauma regarding FA events are factors associated with differences in how families cope with FA.
  
  
• For nut allergic kids and their mothers, prescribing epinephrine autoinjectors is associated with reduced anxiety.
  
  
• Self-reported compliance regarding carrying epinephrine autoinjectors was associated as a burden among food allergic teens and their parents.

FAA and Adults:

• Adults experiencing the psychological burden of FA may notice increased stress levels and negative moods on days with more allergy issues/anxieties.

Interventions and Approaches for FAA Management:

• The overall goal for managing FAA is finding that "just right" level of FAA that allows you to cautiously manage your FA without leading to maladaptive hypervigilance and potentially dangerous risk-taking behaviors.
  
  
• Allergy-informed therapists can provide psychoeducation, psychotherapy, counseling, and teach skills and relaxation/coping techniques to help allergic individuals and families develop the skills to find that balance.
  
  
• Coping with FAA isn't a simple, one-size-fits-all strategy; it requires emotional and behavioral adaptations.
  
  
• Clear, concise and reputable educational materials, especially for newly-diagnosed families, may reduce stress/anxiety levels and improve QoL since it can increase a sense of control (Added FAC note: These FA Stages Handouts are great examples)
  
  
• Messaging and modeling matter: Using a calm, matter-of-fact approach to FA management, which focuses on safety routines and modeling the use of adaptive coping, may convey the message within the family that FA is manageable.​
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Final Thoughts and Takeaways

The hope is that this information has helped you gain a new perspective on food allergy anxiety, better understood your own anxiety, gained more self-compassion, and/or guided you in a useful direction. And if you're a healthcare and/or behavioral healthcare provider reading this, the hope is that this information helps you approach your allergic patients with a much deeper picture of their food allergy anxiety, which is useful in guiding them through the development of anxiety management skills. 

So, what are the main takeaways of this two decade food allergy anxiety research article, and how can you apply them? 

Anxiety is a common aspect of life with food allergy, but it isn't all-or-nothing - it exists on a continuum. There are times on the food allergy journey where anxiety may be more present and intense, and times when we feel we're managing it well. 

Because anxiety is a normal human emotion, it's not a realistic goal to aim to completely get rid of anxiety (even food allergy anxiety), especially as it can actually be motivating and purposeful if we learn how to manage (and use) it effectively. Therefore, it's helpful to focus our attention on developing approaches, skills, and tools that help us find our "just right" balance with food allergy anxiety.

Use these final thoughts as a general guide to help you work towards that "just right" balance: 

• It's helpful to remember my food allergy anxiety feels bad, but can be useful
• I can notice my food allergy anxiety, yet not let it tell me how to live my life
• My food allergy anxiety may be making me feel the risk is higher than it is
• Just because my food allergy anxiety feels big doesn't mean I can't handle it
• What information and tools can I learn to help me turn down my FA anxiety?
• What aspects of life does my food allergy anxiety hold me back from?
• How can I do very meaningful things in life even WITH my FA anxiety?

Please don't hesitate to reach out to an allergy-informed clinical therapy provider if you'd like more support with managing your FAA!

And if you'd like more content focused on food allergy anxiety and the management of it, check out this FAC content: 

• The FAC Blog Category: Anxiety
• The FAC Blog Category: Allergy Anxiety Tools
• The FAC Blog Category: Fears
• Exploring Food Allergy Families podcast - Ep. 10: The Data About Our Feelings with Dr. Ruchi Gupta and Dr. Lisa Lombard (available on all podcast apps)
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