What is food allergy?
If your child has a food allergy, their immune system misinterprets a certain food as harmful and reacts by triggering an allergic reaction. Almost 500,000 Canadian children under 18 years of age have an allergy to food (Soller et al., 2015). The severity of allergic reactions to food is unpredictable and symptoms may range from itchy skin and hives to anaphylaxis. Anaphylaxis is a potentially life-threatening reaction that can affect different parts of the body. Food is one of the most common causes of anaphylaxis in children.
According to Health Canada, the “priority food allergens” or most common foods triggering an allergic reaction are egg, milk, peanut, fish, crustaceans (e.g., lobster, shrimp) and molluscs (e.g., scallops, clams), sesame, soy, tree nuts, wheat and triticale (hybrid of wheat and rye), and mustard.
Food allergy currently has no cure, and therefore, it can be thought of as a chronic medical condition that requires long-term management.
How is anxiety related to food allergy?
Some of the physical symptoms of an allergic reaction (e.g., trouble breathing, dizziness, lightheadedness, feelings of panic, abdominal pain, diarrhea, nausea, vomiting) can be very similar to what we feel when we are anxious. This similarity can make it difficult for some children to tell the difference between feeling unwell because they are having an allergic reaction to something they have eaten, versus having a non-life-threatening experience of feeling anxious.
Managing a food allergy requires a high degree of awareness and vigilance. Exposure to a food that you are allergic to carries risk and can have significant health consequences. At the same time, eating and drinking are essential activities we must do every day to stay healthy and they can’t be avoided! Some anxiety keeps people on guard and helps them to stay safe; too much anxiety can get in the way of our happiness and ability to function each day.
If some anxiety is expected (and even helpful!), how do I know when anxiety related to food allergy has become a problem?
Vigilance about exposure to food allergens is very important to keep children safe, therefore, some anxiety is expected. However, when the anxiety begins to interfere significantly with your child’s involvement in age appropriate activities and/or affects their behaviour, it is considered a problem. For example, the fear of having contact with an allergen may lead some children to make extreme changes in their behaviour to try to avoid this risk altogether. Parents must pay attention to potential changes that may indicate that their child’s anxiety is causing them problems.
What kinds of behaviours might mean that professional support is needed for my child?
- Refusing to attend school or extreme resistance to get there in the morning
- Refusing to participate in extracurricular activities (e.g., birthday parties, playdates, attending lessons away from home)
- Becoming clingier or experiencing distress about being away from caregivers
- Excessive label reading and/or an excessive amount of questions about whether foods are safe to eat
- Excessive hand washing
- Extreme, unnecessary restrictions in eating and drinking
- Significant changes in mood, sleep, or other behaviours
Parents managing a food allergy often worry a lot about their child’s safety and they may experience heightened stress due to the need for constant planning and vigilance to prevent exposure to allergens. Parents need to educate caregivers at school and other settings about how to keep their child safe (and then trust these adults to put the necessary safety procedures in place).
It is important to keep in mind that your child learns from you and models their own behavior after yours, so high levels of parental anxiety and stress can have a negative impact on children. If you find you are spending a lot of time worrying about your child’s food allergy and safety, and it’s impacting your behaviour or ability to function at home or work, you may benefit from meeting with a psychologist specializing in the treatment of adult anxiety.
How can psychologists help children and their families who have a lot of anxiety due to their food allergy?
Psychologists can assist with many aspects of the management of anxiety related to a food allergy.
Cognitive-Behavioural Therapy (CBT)
CBT is a well-studied treatment that has been demonstrated to be effective in treating anxiety in children and youth. CBT is most often used with children 8 years of age or older, but it can also be modified (with a focus on parental involvement) for children as young as preschool age. CBT can help your child learn the relationships between anxiety and unhelpful thoughts and behaviours. Then, your child can be taught ways to think about challenging situations in a more realistic and manageable way. Your child can also be taught strategies to help them identify and better cope with the physical symptoms of anxiety.
Using these strategies, your child can then practice doing activities they are fearful of (like going to playdates or eating something after checking the label a few times instead of many times) in steps that are gradual and safe. This is called behavioural exposure and is an important part of the treatment of anxiety. Psychologists may consult with other health professionals (e.g., allergist, nurse, dietitian) to learn more about specific allergies and to help develop a treatment plan that will be safe and tailored to the unique needs of your child.
CBT is also commonly used with adults to address anxiety that is unrealistic and impairing. Using this treatment approach, caregivers can be taught to recognize unhelpful thinking patterns about their child’s food allergy, learn ways to manage their own anxiety in a more helpful way, and decrease unnecessary interference caused by anxiety related to the allergy.
Self-Advocacy
Psychologists may also help with self-advocacy (e.g., helping your child to be comfortable asking questions about food ingredients and labels, or refusing to eat foods that may put him/her at risk). These skills are important to develop to increase independence, also because bullying is commonly experienced by children with a food allergy (Lieberman et al., 2010).
Oral Immunotherapy
Psychological support may be needed for families exploring or undergoing oral immunotherapy (OIT), a potential treatment for some individuals with food allergy. OIT is a medically supervised treatment in which a person eats small amounts of the food they are allergic to (their allergen) in clinic/hospital and home settings. The amounts of the food allergen are given in gradually increasing doses until the person can eat a certain amount without having a reaction, so long as they are on this treatment. This will help protect them if accidental exposure to the food allergen occurs.
For OIT, families must go from fearing exposure to a specific food with potentially life-threatening consequences and completely restricting exposure, to encouraging a child to eat small amounts of that same food in a supervised way. Understandably, this can result in increased anxiety for the whole family. Psychologists can assist families with decision-making related to whether this potentially life-changing treatment is worth pursuing or continuing, for those undergoing treatment. They can also help children and their caregivers learn tools to manage anxiety they may experience during treatment.
Maintaining a Balance
Individuals with a food allergy must work to avoid their food triggers while also maintaining a high quality of life. A psychologist can help families achieve balance between following prescribed safety practices (e.g. avoiding the food allergen, having an emergency plan, carrying an epinephrine auto-injector such as an EpiPen® when age appropriate) and continuing to participate in activities that are important to the family.
Where can I find more information?
- Visit these websites for additional information:
- Managing Feelings of Anxiety (Food Allergy Canada website)
- Allergy’s High Anxiety: How to Tame Kids’ Fears of Food Reactions (Allergic Living article)
- Consult with a registered psychologistto find out if psychological interventions might be helpful to you and your family. Provincial, territorial and some municipal associations of psychology often maintain referral services. For the names and coordinates of provincial and territorial associations of psychology, visit https://cpa.ca/public/whatisapsychologist/PTassociations.
References
- Lieberman, J. A., Weiss, C., Furlong, T. J., Sicherer, M., & Sicherer, S. H. (2010). Bullying among pediatric patients with food allergy. Annals of Allergy, Asthma & Immunology, 105, 282-286.
- Soller, L., Ben-Shoshan, M., Harrington, D., Knoll, M., Fragapane, J., Joseph, L., Clarke, A. E. (2015). Adjusting for nonresponse bias corrects overestimates of food allergy prevalence. The Journal of Allergy and Clinical Immunology: In Practice, 3, 291-293.
This fact sheet has been prepared for the Canadian Psychological Association by Dr. Joanne Gillespie, IWK Health Centre, and reviewed by Food Allergy Canada.
Date: March 2020
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