Insights on Food Allergy Anxiety: Understanding and Supporting Patients

Announcer:
You’re listening to On the Frontlines of Food Allergies on ReachMD. And now, here’s your host, nurse practitioner Ashley Baker.

Ashley Baker:
Welcome to On the Frontlines of Food Allergies on ReachMD. I’m psychiatric nurse practitioner Ashley Baker, and joining me to discuss food allergy anxiety is Dr. Paige Freeman. Dr. Freeman is a licensed psychologist who specializes in health anxiety. Dr. Freeman, thanks for being here today. 

Dr. Freeman:
Thank you so much, Ashley. I’m really excited to be here. 

Ashley Baker:
To start us off, Dr. Freeman, can you give us some background on food allergy anxiety and why some patients might develop it? 

Dr. Freeman:
Sure. So just to give a personal note that actually might be helpful for this question, I got into this because my youngest was diagnosed with a food allergy when they were three. And as I was navigating this with them as their mom, I was noticing that there were a lot of stressors placed on individuals with food allergies and their parents, and I kept looking for resources to navigate the psychosocial parts of this, but there just weren’t any. And although I didn’t have anxiety that was unmanageable, I recognized that it could happen very easily. One of the reasons that it happens is you’ve got this perfect storm of things that contribute to anxiety, and two of those things are ambiguity and uncertainty, and there is so much ambiguity and uncertainty with food allergies. Then you pair that with the perceived level of dangerousness of food allergies, throw in some trauma from either your kiddo or yourself having or witnessing an anaphylactic reaction, and it’s really a perfect storm for anxiety to get out of hand pretty quickly.

The different information that patients are getting can be very ambiguous, not only from physicians—sometimes across disciplines of physicians—but also sometimes from the same allergist’s office, and so that increases anxiety. There’s a bunch of mom groups, and different things pop up that may either be flat-out disinformation about food allergies or not pertinent to their individual situation, but people are saying that it is, and then it may differ from what their allergist says. And then throwing in food labels and their ambiguity, what does the different labeling mean? What do I particularly need to avoid for me or my kiddo? And what are the laws that are changing surrounding food labels? And so that’s just a taste of the uncertainty and ambiguity. That’s just the tip of the iceberg, and we don’t have the time to go through all of it, but I thought I would share just those few.

Ashley Baker:
And how can it affect a person’s daily life and social interactions? 

Dr. Freeman:
Well, what can happen when you have food allergy anxiety, either about you or your kiddo, is your world can start to get smaller because you start to avoid things that you don’t necessarily need to avoid. And they may get it from sources of information that aren’t necessarily pertinent to them about needing to avoid certain things that their allergist would not say that they need to avoid, but there’s been some breakdown in communication, and the allergist is not realizing how much the patient is actually avoiding in real life. And so it can impact so much, because food is there across every culture. That’s the way we celebrate birthday parties. It’s the way that we celebrate holidays and family gatherings. Or when we’re going out with friends to a restaurant, it’s just pervasive. And when people are avoiding that, it can really affect them socially. And even sometimes when they’re not avoiding it, they go and just grin and bear it, but their anxiety is so high while they’re there, they are not able to be present in the situation in a way that makes these really important social and cultural things that people do for fun worth it, so it can cause a lack of presence and avoidance of things unnecessarily.

Ashley Baker:
So with that important context in mind, how can we best identify when a patient is experiencing food allergy-related anxiety? 

Dr. Freeman:
So I really recommend that you very directly ask a patient, “Are you experiencing some anxiety about your food allergy or the management of your child’s food allergy?” One thing that I want to mention that is so important in pediatrics is that moms are oftentimes really holding it together. It doesn’t look like they have anxiety because they’re trying very hard not to project it on their kid, but internally, they have an enormous amount of anxiety going on that you would not know as the physician because they’re doing a very good job of masking it. And so you want to ask, especially in pediatrics—and away from the kid—how the mom is doing with the management of it. Ask them, “What are you avoiding very specifically?” and see if that seems to be a reasonable degree of avoidance. Also ask them about their ability to live their life in the way that they want to despite the food allergy. Those are good conversation starters to clinically assess whether this is something that needs to be addressed by a mental health practitioner.

Ashley Baker:
For those just tuning in, you’re listening to On the Frontlines of Food Allergies on ReachMD. I’m psychiatric nurse practitioner Ashley Baker, and I’m speaking with Dr. Paige Freeman about how food allergy anxiety can impact patients.

Now, Dr. Freeman, if we switch gears and focus on treatment, what strategies can we use to better support patients struggling with food allergy anxiety? 

Dr. Freeman:
So the most important thing that you can do again is ask them, and once you ascertain that there is a clinically significant amount of anxiety that’s impacting their daily life, then you can validate their experience and the difficulty of food allergy management. Just hearing someone say, “This really is very difficult and hard,” is probably the most important thing that you can do. Encourage a lot of questions and give very clear answers about the level of vigilance that they need and the level of avoidance that’s appropriate. And the way that you can get to this is saying, “What is your worst fear?” And almost every one of these people is going to say that “I’m going to die.” And then you can kind of walk them through what the research says and what the statistics are, so they can have a clear, clinically supported idea of what we know about the risk of that. 

Ashley Baker:
And can you tell us about the resources that are available for clinicians to help patients navigate allergies and related anxieties? 

Dr. Freeman:
Sure. So I have on my website—paigefreemanphd.com—several lengthy podcasts that address food allergy anxiety, ways to manage it, and a whole bunch of other topics. Another place that I really recommend is foodallergycounselor.com, which has a lot of helpful articles. There are podcasts and worksheets there too: all kinds of things that are just fantastic. And then if you think that your patient needs to actually see a mental health practitioner, there is a group of us that you can find on foodallergycounseling.org called the American Academy of Food Allergy Counselors. 

Ashley Baker:
As we come to the end of today’s program, Dr. Freeman, do you have any final insights you’d like to leave with our audience? 

Dr. Freeman:
I think that it is very important when you’re talking about food allergies to actually refer out to someone who is familiar with allergic disease and food allergies specifically, because I have seen a lot of patients that have had some significant damage done by people who don’t understand the seriousness of food allergies. And also, a lot of time is wasted, because the patient is having to educate a therapist at length about everything from OIT and SLIT to oral food challenges: all these different things that people who do not specialize in allergic disease don’t really understand. And it’s really a burden on the patient because they have to do so much education.

Ashley Baker:
Those are great takeaways for us to think on as we wrap up our program. And I want to thank my guest, Dr. Paige Freeman, for joining me to discuss the impacts of food allergy anxiety.

Dr. Freeman, it was great having you on the program. 

Dr. Freeman:
Thank you so much. It was really my pleasure to be here. Thank you for having me.

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