Category: Anaphylaxis

Post-Anaphylaxis Tool

5/10/2022

Since we typically tend to avoid even thinking about the possibility of a reaction and the reaction “What ifs?!”, it usually feels even harder to process a reaction if it DOES happen.

The truth is, after a reaction, especially if it was anaphylactic, we may feel as if we’ve been thrown way off course - maybe even sent right back to how we felt upon diagnosis. We may experience a loss of trust in others, labels, and even our own allergy skills....or ourselves.

And even though we can visualize where we want to get back to - a place of confidently navigating allergies again - we may struggle to find our way back there.

Know that this is a normal response to an allergic reaction! But even knowing this still may not make us feel better about the post-reaction fear and uncertainty we experience, and the time it is taking to work through it. We dislike discomfort, and therefore, we want to get back to our comfort zone ASAP!

Enter the T.R.AC.E. tool!

I created T.R.A.C.E. in 2019 to serve as a "compass back to confidence" after someone has a food allergy reaction or allergic condition flare up, and debuted it at the 2nd Annual Food Allergy Conference for Education and Science - FACES (and FYI - the 2022 FACES Conference is in June!)

The T.R.A.C.E. tool offers reminders to keep us grounded during the post-reaction rebuilding phase. The truth is that it takes time - sometimes more time than we want - to process the reaction and make sense of how we move forward. And we need to give ourselves that space and time to process things, but sometimes feel lost during that timeframe.

Therefore, using the T.R.A.C.E tool gives you tangible actions to take during these processing and rebuilding phases. And while we may think this information seems like common sense, sometimes common sense escapes us when we’re anxious, stressed or traumatized! Therefore, it's good to have this available, just in case.

If you want to keep the T.R.A.C.E. tool handy, or want to share with your patients, you can find a free PDF download of this tool on the “Worksheets” page, or use this direct URL: www.FoodAllergyAnxiety.com

Looking for more on the topic of working through emotions and thoughts after anaphylaxis? Check these resources out, too:

Remember, support is out there if you need it! Don't forget to check out the Food Allergy Counselor Directory, the Exploring Food Allergy Families podcast, the Food Allergy Behavioral Health Resource section, and the allergy-specific therapeutic worksheets. And if you're an allergy-informed therapy provider, then visit the Provider page!

----> And don't forget to sign up to receive helpful allergy psychosocial tips and updates via email! Subscribers also get the free "Allergy Anxiety and Overwhelm Mini Guide".

Do you value the Food Allergy Counselor Directory and the support it provides to the allergy community? Want to see it expand with additional providers? Contact founder Tamara Hubbard, LCPC for sponsorship opportunities!

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2021 FAAW Tips from the Food Allergy Counselor

5/15/2021

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Food Allergy Awareness Week (FAAW) 2021 may be over, but the education and advocacy efforts won't stop! Together, we will continue to educate the general public and work to make a difference in the lives of those managing food allergies and allergic conditions.

As part of this community, here is my ongoing commitment to this effort:

I will continue to think outside of the box to offer new allergy-related psychosocial guidance and tips;
I will continue to create practical resources beneficial for those managing allergies and for allergy clinics to share with their patients;
I will continue to actively be involved in efforts to emphasize the need for multidisciplinary allergy care;
I will continue to educate licensed behavioral healthcare providers about food allergies and the support needs of the food allergy community;
I will continue to help grow the food allergy counseling niche in order to increase the number of allergy-informed licensed behavioral healthcare providers available to support this community

I commit to continuing to be a change maker regarding food allergy mental health - having the conversations, building the relationships, identifying the gaps and then helping to fill them!

In the meantime, if you've missed any of the 2021 FAAW tips offered this week, you can review them all below, including the additional guidance offered for each one.

DAY 1 - Sunday, May 9th, 2021:

In honor of all of you amazing allergy moms, and the first day of Food Allergy Awareness Week (FAAW), here are the results from the 1st question on the "2020 Food Allergy Mom Experience Survey". What do you think of these results? Why do you think 57% of moms surveyed felt allergy moms don't speak up about their experiences enough? (Full anonymous survey answers will be shared in an upcoming blog post).

Check out Exploring Food Allergy Families podcast episode 15 for full results from the moms' survey. Find it on the Podcast page or on any podcast app - Apple Podcast, Spotify, iHeartRadio, etc

DAY 2 - Monday, May 10th, 2021:

Today's FAAW tip is focused on reframing anxious allergy thoughts. Let's start with some helpful reminders about anxiety:

Anxiety is a useful emotion that helps us assess for safety, and prepares and motivates us towards action
Just because we feel physical sensations of anxiety or experience anxious thoughts, doesn't mean things are bad or will go wrong
It may not be realistic (or useful) to aim to completely get rid of anxiety; it's more realistic to learn how to manage it or create a new relationship with it

One helpful strategy for managing anxious allergy thoughts is to reframe them. To help your mind develop more workable responses to them. Even the tiniest of mindset shifts can result in unhooking from the worry enough so you can focus on ways to move forward rather than stay stuck.

You can find the following worksheets (and more) to help manage allergy anxiety and worry in the "Worksheets" section:

Managing Food Allergy Worries & What Ifs Worksheet
Food Allergy Thinking Traps Worksheet
Food Allergy Mindset Matters Worksheet
Oral Food Challenge anxiety-specific worksheets

COMMUNITY QUESTION: What helps you or your child manage their allergy-related anxiety or worry?

DAY 3 - Tuesday, May 11th, 2021:

Today's FAAW tip is all about the urge to control when we feel overwhelmed, anxious or fearful of allergies. This is usually triggered by the unpredictability and uncertainty that comes along with food allergy life.

Wouldn't it be ideal if we could always control every risk possible? Unfortunately, that's not a realistic goal, nor is it actually helpful! While trying to control things may decrease the discomfort you feel from the worry, it's a temporary relief which usually leads to increased and growing anxiety over time. More and more energy goes into trying to stay ahead of everything, and when that gets too hard, avoiding people, places and things will start happening. Trying to control also robs you of opportunities to learn and grow - to focus on figuring out what you need to confidently get through tough situations (or thoughts/feelings).

Rather than AIMING TO CONTROL, think about HAVING INFLUENCE OR IMPACT on situations, especially daunting ones.

COMMUNITY CHALLENGE: The image below is just an example to help you process your own list for yourself, or if you're a parent, for your child. Grab a sheet of paper, draw the image below, and have fun exploring just how much impact you have on your ability to decrease anxiety and increase confidence!

COMMUNITY INPUT: What else would you add to this list, in either section?

FAAW BONUS - New "Urge to Control" worksheet, which can be found in the Worksheets section on this website:

DAY 4 - Wednesday, May 12th, 2021:

Wednesday's FAAW tip focuses on your food allergy mindset, because it matters!

Ask yourself these questions to help assess your allergy mindset:

Do you think you/your child's life can't be normal?
How do you feel about managing a reaction?
How does your child feel about managing their food allergy?

These questions relate to your mindset, or whether you believe the qualities you possess make you capable of handling situations. People can have a "fixed" or "growth" mindset. Think of these as the type of glasses you're wearing - the lenses with which you see things. When wearing "fixed mindset" glasses, you're more likely to believe that you're not able to deal with whatever you're being faced with. With "growth mindset" glasses on, you're better able to envision yourself getting through roadblocks that are standing in your way.

Our mindset may change depending on situations we're in or experiences we've previously had. You may feel confident navigating some parts of life with food allergies, while feeling incapable of managing the aspects that you're most fearful of. But by subscribing to a growth mindset, you're allowing yourself the ability to grow confidence, manage anxiety, and essentially handle even the hardest of situations.

Community Challenge: Pick one allergy-related thought to try and reframe into a growth mindset-focused thought. If you're a parent, help your child use growth-mindset language - "I'm not comfortable with this, YET!" or "I'm still learning by practicing with my epi!"

To help practice this concept, you can download the "FA Mindset Matters" worksheet from the Worksheets section. To read more about growth mindset, look up Carol Dweck and her books.

DAY 5 - Thursday, May 13th, 2021:

Thursday's FAAW tip offers a problem-solving method that's helpful for when the fear and anxiety feel overwhelming.

When you need to make a decision but your emotions are taking over, having a problem-solving tool to help navigate the scenario can be beneficial. That's where the I.D.E.A.L. Method comes in! This technique helps define the main problem in a situation, and guides you through creating and evaluating solutions. Essentially, it helps you look at things more objectively.

Benefits of the I.D.E.A.L. Method:

It's an easy-to-use tool that you can use yourself, teach to your child/teen, or even use as a family when there's a decision needing to be made
It aids in balancing the emotions and the facts - essentially helping you become "unstuck"
By using this tool, it helps decrease the power of the fearful emotions, and increase the focus on where you DO have control or impact in a situation

.
Community Challenge: Choose something you feel stuck navigating lately and use the I.D.E.A.L Method steps to help you feel less stuck and better able to consider potential solutions.

The "I.D.E.A.L. Method " worksheet can be downloaded from the Worksheets section.

DAY 6 - Friday, May 14th, 2021:

Friday's FAAW tip has to do with processing the emotions associated with yours or your child's food allergy diagnosis. Avoiding allergens is helpful, but avoiding emotions isn't!

Of course you can recall the feelings you felt the day you learned about the food allergy, but have you connected with the stories that came out of it? When we experience something as emotional as a life-changing diagnosis, there's often a narrative that our mind attaches to - sometimes so quickly that we don't even notice it. It just sort of sneaks in and we don't take time to acknowledge it, let alone process it.

In the case of food allergies, we immediately jump into action - doing, learning, avoiding, protecting. We may process the surface thoughts and feelings, but the deeper emotions and stories likely stay put because there's no time or energy for that work. But what happens when we don't make the time to process them? They find ways to come back up, especially when we feel vulnerable, such as after another reaction or during a life transition that leads to increased emotions again. And those stories we told ourselves about the early experiences with food allergies have the ability to impact our allergy mindset - changing how we manage it all in the future.

Yes, it's uncomfortable to revisit that time in our minds, but it can help unhook you from unhelpful narratives that may keep you from moving forward in the way you want to on this allergy journey, especially if those narratives are focused on blame, guilt, and self-judgement. This image shows some of the emotions and diagnosis narratives that may be experienced. This isn't an exhaustive list, so use it as a starting point to help you identify your own. Use self-compassion and kindness with yourself as you process these, just as you'd offer a friend. Notice if you're still holding onto anything internally that's keeping you stuck, pushing you around or derailing you from being the allergic person or parent you want to be.

If you feel you need the support of processing this with a licensed therapist, you can find an allergy-informed one via the Food Allergy Counselor Directory.

DAY 7 - Saturday, May 15th, 2021:

Saturday's FAAW tip offers a post-reaction compass to help rebuild confidence and decrease anxiety after anaphylaxis through the T.R.A.C.E. approach.

It's very common to feel like a reaction, anaphylactic or not, has set you back emotionally and decreased willingness to live fully due to fear of another reaction. This is a normal response to a traumatic situation, so allowing yourself to honor those thoughts and feelings is a part of the healing process. But once the initial overwhelm from the reaction settles a bit, it's important to create your game plan to build your confidence again. Without this step, you risk staying stuck, hooked by fear and catastrophizing thoughts that keep you unable to truly move forward in a way that benefits yourself and/or your child.

T.R.A.C.E. is an easy way to remember the key components of this rebuilding process. It takes time to rebuild trust, getting back to a routine, reviewing with your allergist, practicing tons of compassion, and educating yourself on anxiety and to fill the knowledge gaps.

Community Conversation - what has helped you and/or your child move forward after a reaction?

You can find a free downloadable worksheet version of T.R.A.C.E. in the Worksheets section.

I hope you were able to share or learn new things this Food Allergy Awareness Week. I'd love to hear from you - what were some of the best tips
you learned or share this week?

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Tips for managing oral food challenge anxiety

4/19/2021

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You've likely heard the term "oral food challenge" mentioned by your allergist or in online food allergy support groups. But if you haven't, here's a quick primer from the American Academy of Allergy, Asthma and Immunology on oral food challenges:

What is an oral food challenge?
An oral food challenge (OFC), or feeding test, is a medical procedure in which a food is eaten slowly, in gradually increasing amounts, under medical supervision, to accurately diagnose or rule out a true food allergy.

What are the reasons to perform an OFC?
OFCs are usually done when a careful medical history and allergy tests, such as skin and blood tests, are inconclusive. The OFC is a more definitive test because it will show whether the food ingested produces no symptoms or triggers a reaction.

Oral Food Challenge (OFC) Anxiety and Worry:

Given that during oral food challenges you are eating a food that you may potentially be allergic to or have previously been allergic to, it's no surprise that you may feel anxious and worried in anticipation of that appointment - many do. Our mind wants to keep us safe, so an oral food challenge can feel like a potential threat to our mind when we think about it. Therefore, it's normal and appropriate to experience anxiety about oral food challenges. However, it's important to remember that you don't need to interpret that anxiety to mean that the oral food challenge will result in the worst case scenario.

What Helps OFC Anxiety and Worry?

When you experience increased anticipatory anxiety - that is, anxiety about a future event, it can be helpful to prepare for the event in order to to increase readiness and decrease fear.

Here is a brief list of ways to prepare ahead of time for your or your child's oral food challenge:

Purpose/Process: Do you understand the purpose and process for the oral food challenge? It's important to have a good understanding of these things before the actual appointment, so reach out to your allergist if you're unsure.
Information: What other questions do you or your child have about the food challenge? Will you reach out to your allergist ahead of time to ask these questions? If not, what reputable sources can provide this information?
Motivation: Connect with your motivation for doing the food challenge, whether it's for yourself or your child. Reconnecting with hope and thinking about what you may gain from doing the challenge can help when feeling nervous.
Thoughts/Feelings: Notice what thoughts and feelings you're having about the food challenge. How do they make your body feel? If your child is doing the food challenge, help them notice and explore their thoughts and feelings, too. Develop a list of empowering replies to these thoughts such as "I can do hard things!" or "The allergist and nurses know what they're doing!"
Calming Strategies: Practice some calming strategies ahead of time so that you're familiar with them for the appointment. Here are a couple of simple calming strategies you can try:
- For teens or adults (Square or Box Breathing) - Exhale to a count of 4, then hold for a 4 count. Inhale to a count of 4, then hold air in your lungs for a count of 4. Exhale and repeat the pattern.
- For kids (Cupcake & Candle Breathing) - Inhale like you're smelling a yummy cupcake, and then exhale like you're blowing out the candle on it. Repeat as many times as necessary.
- 5-4-3-2-1 Activity - Notice 5 things you can see. Notice 4 things you can touch. Notice 3 things you can hear. Notice 2 things you can smell. Notice 1 thing you can taste. This helps stay present-focused rather than worrying about future things.
Logistics Preparation: What do you need to bring with to the oral food challenge appointment. Create a list of food items you may need (i.e. allergen, food to put allergen in for consumption) and fun or distracting games or activities. If the food challenge is for your child, have them help you brainstorm game or toy ideas for the appointment. Also be sure to bring along any comforting items that may help decrease anxiety and increase calm.

Additional Resources and Tips to Help Manage OFC Anxiety

PODCAST EPISODE:
Be sure to listen to Episode 14 of Exploring Food Allergy Families called, "Tips for Managing Oral Food Challenge Anxiety & Worry". In this episode, fellow allergy-informed therapist Fawn McNeil-Haber, PhD and I discuss helpful strategies for navigating oral food challenges. We offer preparation tips and guidance on navigating anxiety and mindsets prior to and during the food challenge. Here are specific topics we explore in this episode:

Strategies to navigate nerves during the actual OFC appointment
The importance of having a mantra
Tips to help determine anxiety versus allergic reaction sensations
How far in advance to tell your child about an OFC
Tips to encourage readiness and decrease anxiety for kids, teens, parents and adults
Answering the question "How does the allergist know what's happening in my body?"
A fun idea parents can prepare for the actual appointment

You can listen via your favorite podcast app, including Apple Podcasts, Spotify, and iHeartRadio. Don't forget to subscribe so you don't miss future episodes!

ORAL FOOD CHALLENGE PREPARATION WORKSHEETS:
Check out these Oral Food Challenge worksheets which help prepare before the appointment, offer helpful reminders for the day of, and prompts for processing after the food challenge. (There are separate worksheets for kids and teens/adults). Also check out this post on a post-anaphylaxis tool known as T.R.A.C.E, which is a compass guiding you back to confidence after allergic reactions.

You can find these worksheets on the Therapeutic Worksheets page here on the Food Allergy Counselor website.

Hopefully reading this and checking out the podcast, worksheets and other resources offers you some reassurance that oral food challenge-related anxiety is normal and manageable. Don't hesitate to reach out and let me know if these tips have helped you or your patients, or to share tips of your own! And if you're looking for an allergy-informed therapist in your state (many of whom provide telehealth to residents of their state), visit the Food Allergy Counselor Directory.

You can connect with me on Twitter (@TherapistTamara and @FACounselor), Instagram (@TherapistTamara & @FoodAllergyCounselor) and Facebook (@FoodAllergyCounselor and @TamaraHubbardLCPC).

Thanks for reading!

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