Afraid of a Reaction


How to manage allergy anxiety

The experience is all too familiar. You sit down for a meal and take a bite of a supposedly safe dish. Then something starts to happen. Your chest feels tight, your breathing quickens, your lips and throat seem to tingle. Are these early signs of an allergic reaction? In that moment of anxiety, it can be difficult to know for sure.

Living with severe milk and nut allergies, I’ve experienced this scenario many times. Eating somewhere new and unfamiliar can make me feel tense and more than a little bit anxious, especially when things don’t go as planned. When it’s challenging to find a safe dish on the menu or the waiter doesn’t seem to understand my needs, it makes these feelings worse. My anxiety can build as I feel less confident that my meal will be safe.

And then as I take that first bite, I start to feel what I think are the telltale signs of a reaction. My heart pounds, my breathing speeds up and I swear that my mouth is starting to itch. My mind racing, I quietly push the food around my plate, wondering if it’s time for an antihistamine or worse…

When you have a severe food allergy, it’s natural to worry about staying safe, particularly in a new environment. A little bit of concern is helpful—it prompts you to read ingredient labels one extra time or double-check when the waiter delivers your meal. But what happens when worry transforms into disruptive fear that keeps you (or your food-allergic child) from enjoying a normal life?

Running Scared

Sloane Miller knows firsthand that food allergies can cause anxiety. In her book, Allergic Girl, she recounts an incident that occurred while she was traveling in Venice as a teenager.

After the first bite of pizza, my stomach felt hollow, my hands started to tingle, my mouth felt funny, and my throat—what was happening to my throat? Was it closing? Was it getting tight? Was I choking?

In a panic, Miller ran out of the restaurant and dashed through the streets toward her hostel. She was terrified, her heart racing and a sense of impending doom closing in on her. Yet as she neared the hostel, she stopped to take stock of the situation. She found she could breathe easily and her skin was clear of any rash or hives.

It wasn’t an allergic reaction, she realized. It was a panic attack.

All of Miller’s symptoms—shortness of breath, heart palpitations, tingling sensations, a feeling of choking, a sense of impending doom—are clinical signs of both a panic attack and anaphylaxis. It’s no wonder that such an experience can be confusing and terrifying.

An allergic reaction differs from a panic attack (or other anxiety disorder, such as phobia) in one very important way: the risks of anaphylaxis are significant and very real. Unlike a fear of planes, heights or spiders, allergy concerns are normal and rational.

“Yes, we need to be concerned and vigilant,” Miller says. “But hyper-vigilance creates a level of stress and discomfort that ultimately isn’t helpful.”

Signs and Symptoms

How can you recognize when you or your food-allergic child has unhealthy allergy anxiety? Although some experience symptoms as severe as panic attacks, the problem more commonly involves everyday anxiety that limits the ability to function. According to Nancy Rotter, PhD, a pediatric psychologist at the Food Allergy Center at Massachusetts General Hospital, the most important indicator of unhealthy anxiety in a child with food allergies is whether the allergies are preventing them from living a complete and full life.

“The goal is management, whether it’s managing anxiety or the food allergies themselves,” says Rotter. “The most important thing is to find strategies to do this so that your child can enjoy a comfortable and full life despite the challenges.”

For a food-allergic child, this means participating in extracurricular activities and sports, attending school consistently, spending time with friends and going to birthday parties and other social events.

For food-allergic adults, the same rule applies. You should feel that you are able to participate in activities that are important to you, such as attending dinner parties, dining out with friends or going on dates. If you notice that you’re avoiding events that used to be enjoyable, it can be a red flag for excessive anxiety.

“When anxiety becomes overwhelming and interferes with life functions, then you know you’re dealing with something larger and you should seek additional help,” Miller says.

Anxiety about food allergies is a relatively common experience following initial diagnosis, during major life transitions (such as moving away to college), or in the aftermath of a close call (a severe allergic reaction). A period of adjustment can be expected.

“For a person who’s newly diagnosed, it’s natural and normal to have a heightened state of vigilance and anxiety and perhaps feelings of depression, avoidance, trauma or anger,” says Miller. “The danger is when you get past that adjustment period and you’re still experiencing those feelings.”

“A fairly common scenario is when a child has accidentally ingested something they’re allergic to and has a reaction requiring medication, such as injected epinephrine,” says Rotter. “This experience, which can be quite frightening for the child, can trigger subsequent anxiety.”

When heightened fear persists, becoming long lasting and disruptive, it can indicate unhealthy anxiety. Some behaviors to watch for include:

  • Regularly skipping social events or activities,
  • Restricting eating to a limited number of foods not associated with the allergen(s),
  • Asking repeatedly for reassurance from parents, friends or wait staff,
  • Having trouble sleeping due to worrying about allergies,
  • Severely limiting day-to-day activities because of worry about cross-contact from everyday objects, and
  • Having to complete allergy-management tasks repeatedly or excessively (e.g., washing and re-washing hands, reading labels over and over again).

Each of these signs comes with caveats, of course. Strategies for staying safe vary from person to person. With particularly severe food allergies, it’s normal to be extremely cautious, frequently washing hands and wiping down surfaces. However, for someone who’s unlikely to have a severe reaction without ingesting the allergen directly, these same habits could signal unhealthy anxiety.

Helpful Steps

Know Your Allergy One of the first steps in dealing with allergy anxiety is to have an in-depth discussion with an allergist. You should fully understand the risks associated with your allergy.

“There’s a great deal of uncertainty around food allergies, which can lead to anxiety,” says Jennifer LeBovidge, PhD, a pediatric psychologist at Children’s Hospital Boston who specializes in teaching allergy-coping skills to children and families. “If you’re uncertain about the level of risk posed by a certain situation, check with your healthcare provider. Without the facts, it’s easy to worry and difficult to come up with a good plan.”

Some individuals can experience allergic symptoms from food particles in the air or skin contact. Others get symptoms only when they directly ingest the food; if airborne or contact reactions occur, it’s likely they’re less severe.

The better you understand your diagnosis, your specific sensitivity and set of risks, the more confidently you’ll be able to function.

Find a Network A good support system is an invaluable weapon against excessive anxiety. Simply sharing experiences with others can reduce allergy anxiety.

“Support groups provide invaluable information, understanding and proof that food allergy is manageable,” says LeBovidge. “Rather than bottling up anxieties, talking about them and sharing management strategies can have a therapeutic effect.”

Venting negative feelings to a trusted friend or family member—one who knows and understands your allergies—can help decrease undue anxiety, agrees Miller.

“Anxiety makes you disconnected. When you’re in an anxious moment, you’re totally in your head and you’re all alone. It’s important to break that cycle, realize that you’re not all alone and share it with someone,” she says.

Have a Plan When working with food-allergic children, LeBovidge collaborates with their allergist to develop a coping plan appropriate for each patient’s specific diagnosis. This plan outlines in detail how a child and parents should navigate any challenging situations that may arise.

“When people have a plan to handle a situation they’re worried about, they feel more prepared and confident,” she says.

From this plan, LeBovidge then develops a strategy for gradually working through anxious feelings. Like treatment for phobias and other anxieties, exposure to the situation that creates anxiety is an important part of dealing with the issue.

To accomplish this goal in a safe and comfortable manner, LeBovidge helps children break down the process into small steps. If a child is anxious about eating at a restaurant, for example, she begins simply by discussing the anxiety and understanding what the child is concerned about. She then helps them practice how to ask questions and pick safer food options. The next step may involve going to a restaurant but bringing food along that was prepared at home. The next time, they might order a drink and then finally order from the menu. With each outing, the child takes a small step toward confronting anxiety while also learning to keep safe.

Get Professional Help It’s perfectly understandable to feel anxious sometimes, stresses LeBovidge. “Anxiety associated with food allergy is a normal experience, given the risks of serious reactions. Some degree of anxiety is normal and perhaps even adaptive.”

But when anxiety regularly gets in the way of living life, it may be beneficial to seek professional help. Mental health specialists treat anxiety using proven techniques, such as cognitive-behavior therapy.

LeBovidge works with those who have allergy-related anxiety to identify their symptoms and understand why they occur. In addition, she teaches relaxation strategies, such as breathing techniques, to help reduce panic symptoms. With a cognitive-behavioral approach, most patients can effectively work through anxiety around food allergies, she says. The goal is to help patients understand which anxiety is realistic and helpful and which is excessive and unhealthy. Treatment should reinforce appropriate vigilance and allergy-management strategies.

A Balancing Act

Finding a balance between vigilance and anxiety is a challenging and ongoing process.

“One has to learn what are good, careful, best practices for safety and health and what is overdoing it,” says Miller. “For everyone, it will be different. And at different life stages, it will change.”

Beyond keeping yourself or your child safe, the most important goal of food-allergy management is to lead a happy, active life. There is no question that living with severe food allergies can be a challenging and sometimes anxiety-provoking task. Having to constantly check labels, question friends and inquire at restaurants can be stressful and trying, especially when adjusting to a new diagnosis or in the aftermath of a severe reaction. Yet there’s a difference between living with a food allergy and letting it control your life.

It’s essential to evaluate whether you or your child are practicing healthful vigilance or experiencing unhealthy anxiety, to consider whether you’re happy with the balance between the severity of your allergies and the range of activities open to you. This balancing act is one that food-allergic individuals must deal with throughout their lives but it’s not something they have to deal with alone. LW

Joshua Feblowitz, who has severe milk and nut allergies, is a freelance science writer and a student at Harvard Medical School.