Counseling for Managing Allergies

More allergy and immunology research is focusing on the psychological burdens and social impacts of living with food allergy. Common food allergy psychosocial burden themes include: 

• Psychological: anxiety, worry and fear associated with to the unpredictable nature of food allergy, as well post-anaphylaxis trauma 

• Stress: ongoing stress related to daily allergen avoidance, food choices, and food purchasing and preparation 

• Developmental: interference with age-appropriate development and transitions

• Family Systems: impacts on various family members, including parents/caregivers, siblings, and extended family relationships

• Social: isolation, exclusion, bullying, and impacts on social activities

Additionally, research has also begun exploring therapeutic interventions to assist food allergic individuals and families more effectively manage these burdens and navigate through each age and stage more confidently. 

Food allergy anxiety is often focused on specific fears and phobias related to food allergy management and safety. Common food allergy anxiety triggers include fear of an allergic reaction or anaphylaxis, fear of death, needle phobia, and social exclusion. These specific fears and phobias combined with the stress of ongoing, daily vigilance can lead to behaviors and actions that negatively impact quality of life, which further fuels the food allergy anxiety cycle. This might look like restricting life experiences, such as not traveling or eating out at restaurants, over-avoidance of social situations, unwillingness to introduce new foods to a child, and restrictive eating patterns. 

So, what’s the goal for managing food allergy anxiety? While completely extinguishing the anxiety would feel good, that’s not realistic. It’s appropriate to experience anxiety when managing a food allergy, and therefore, the goal is to find the “just right” balance between that allergy anxiety and your quality of life. In fact, low to moderate levels of food allergy anxiety can be a useful tool, helping you to remain safe. However, with high levels of food allergy anxiety, we tend to overestimate the risks of casual allergen exposure and underestimate our ability to manage a reaction. 

Therefore, if you find that your food allergy anxiety impacts daily functioning and/or is leading to overly-avoidant behavior patterns, it’s likely time to reach out for additional support from not only a behavioral healthcare provider, but also your allergist. Focus on gathering information that addresses and clarifies your fears, as well as helps you develop skills that lead to building confidence in managing your food allergy. Reputable resources for this include: 

• American Academy of Allergy, Asthma, and Immunology

• American College of Allergy, Asthma, and Immunology

• Food Allergy Research and Education (FARE)

• The Food Allergy Counselor, Inc.
  
  

The food allergy diagnosis period tends to include a whole array of thoughts and emotions. Common diagnosis–related emotions include sadness, anger, disbelief, frustration, fear, trauma, especially if the diagnosis occurred post-allergic reaction, and even relief. Common thoughts typically include “I don’t believe this is happening!”, “I’m not going to be able to keep myself safe” and “My child won’t have a normal life.” These emotions and thoughts may feel debilitating at first, but it won’t always feel that way!

When you receive a food allergy diagnosis, it’s important to give yourself time to not only honor those internal experiences, but also to accept the diagnosis. Because living with a food allergy often involves gathering tons of new information and making lifestyle adjustments, accepting and confidently living with the food allergy won’t happen overnight. It may take months to process and find your groove, but this is all a normal part of the diagnosis journey. 

Focus on identifying information that helps you develop your food allergy management plan, and the skills you’ll need to learn to find a balance between the fear and your ability to still live the life you want to live. Don’t hesitate to reach out to your allergist with any and all questions to help you adjust. These food allergy ages and stages informational handouts from the American Academy of Allergy, Asthma and Immunology are a great resource to help you develop a workable approach to life with food allergy.

While allergy-specific and emotional psychoeducation is useful in addressing disordered or restrictive eating patterns and health anxiety, the treatment plan should include additional therapeutic approaches.

In recent studies, Cognitive Behavioral Therapy (CBT) and Exposure Therapy have been shown to be effective in helping people manage their food allergy anxiety. These approaches help individuals identify unhelpful thoughts, emotions and behaviors in an effort to develop more effective ones. Additionally, through graded exposures to feared stimuli and/or avoided situations, individuals are gradually exposed to experiences that help them to tolerate their discomfort, more effectively assesses risk levels, and lessen their anxious avoidance. An important note is that these are not exposures to one’s food allergen; rather, they’re exposures to safe items, scenarios, and experiences, as exposures to allergens should only happen under the guidance of an allergist.

One specific restrictive eating pattern to be aware of and assess for when working with allergic individuals is Avoidant Restrictive Food Intake Disorder, or ARFID. Unlike eating disorders centered on body image, ARFID is based on concerns about aversive consequences of eating, leading to extreme pickiness and restrictive eating behaviors. ARFID is likely underrecognized in the food allergic population, and typically requires a multidisciplinary approach to effectively address it. 

Currently, there are no specific certifications or training programs for food allergy and allergic disease counselling/therapy, although more recently, there have been efforts to explore solutions for this gap. However, there are several ways to become better-informed about this growing niche! In addition to the suggestions below, it’s helpful to stay on top of the latest research by looking on PubMed for articles and data relating to food allergy management, psychosocial impacts, and therapeutic interventions. 

Educate yourself on the latest research and evidence-based information on the medical aspects of food allergy and allergic diseases via content from:

• American Academy of Allergy, Asthma and Immunology (AAAAI)

• American College of Allergy, Asthma and Immunology (ACAAI)

Familiarize yourself with the psychosocial impacts and burdens experienced by allergic individuals and families via content and webinars from: 

• Food Allergy Research and Education (FARE)

• Asthma and Allergy Foundation of America (AAFA)

• National Eczema Association (NEA)

Additionally, to help bridge the current gap, I’ve developed a resources for behavioral healthcare professionals interested or already working in this niche, including: 

• Psychosocial and quality of life resource library of links

• Introduction to Food Allergy Counseling 101 webinar

• Evidence-based educational workshops and webinars for behavioral healthcare professionals interested in joining this niche or expanding their knowledge and skillset if they’re already working within this niche (available via The Food Allergy Counselor, Inc in 2023) 

• Food Allergy Behavioral Health Network (professional membership program benefit)

It’s no surprise that receiving a diagnosis of and living with a life-threatening food allergy is life-impacting. However, there are many ways in which people can help themselves thrive while living with a food allergy!

• Befriend Your Food Allergy Anxiety – Exploring and addressing the fears behind your anxiety will help you develop a workable relationship rather than staying in struggle with your food allergy anxiety

• Evaluate Your Rigid Allergy Beliefs – Consider ways to add more flexibility to aspects of your life that feel very rigid

• Develop a Growth Mindset – This helps you believe that you can face challenges that come your way, even ones related to safety

• Remember Your “WHY” – Identify why pushing through allergy fears to get to the other side is important – what will you learn about yourself and your capabilities?

• Fill Your Toolbox with Plenty of Tools – Ensure that you have a variety of food allergy-specific skills and emotional health/coping strategies identified and available to use during times when you feel stuck in struggle