The psychosocial impact of FA in children, adolescents, and families

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Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and
their families: a review. Allergy 2010; 65: 933–945.


Very good review article from 2010.

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another relating anxiety and allergic conditions-- though I would caution ANYONE from relying too heavily upon this particular source, as the authors are, IMO, operating way outside their scope of expertise here...

Allergies and Anxiety in Children and Adolescents

They don't discern between adaptive and maladaptice anxiety at all in that treatise, and they also posit a biological underpinning for a common cause of both anxiety disorders AND atopic conditions, which would be fine, but they also note that in the few studies included in the review which parsed severity, guess what?  That's right-- more severe Hx in allergic conditions also led to more severe anxiety.  Go figure, right?     Cognitive basis, much?

[twinturbo]

Want to add that it should be noted by us all, either pro or con, no one can perform anxiety experiments on kids with FAs to draw conclusions because no review board is going to waive the ethical requirements for human test subjects so blatantly, particularly children. The best data is almost exclusively from observation and self-report or parent report. The problem I see in many of these papers is they don't ever seem to acknowledge that an emotion can resolve only when the stimulus is taken away. If the stimulus is perpetual then there's no reason the emotion would resolve.

I'm trying to remember the other thing DH & I were looking at, I think it was population and sample bias because the reports they would read over tend to be the most anxiety prone reports, so whether it can be generalized that's yet another wide swathe. And again, if a pathological lens is already in place looking for observational reports to fit it... not much investigation going on there.

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Developmental pathways in food allergy: a new theoretical framework


This one relates to the developmental impact of living with a food allergy.

It's VERY good, though J. O'B. Hourihane is one of the corresponding authors...  (he of the "epinephrine is WAYYYYYY over-prescribed in the UK" fame).

Background:  To date, there is no model of psychosocial development based on empirical food allergy (FA) research. This limits the ability of clinicians, researchers and policy-makers to predict and evaluate the real impact of FA on the child, with implications for prevention, treatment, intervention and health policy.

Objectives:  To provide an integrated conceptual framework to explain the onset, development and maintenance of FA-related cognitions, emotions and behaviour, with particular attention to transition points.

Method:  Fifteen focus groups meetings were held with 62 children (6–15 years). Developmentally appropriate techniques were designed to stimulate discussion, maintain interest and minimize threat to children's self-esteem. Data were analysed using grounded theory.

Results:  FA impacts directly on children's normal trajectory of psychological development in both an age- and disease-specific manner. Six key themes emerged from the analysis: 'meanings of food'; 'autonomy, control and self-efficacy'; 'peer relationships'; 'risk and safety'; 'self/identity'; and 'coping strategies'.

Conclusions:  Coping with FA is more than simply a strategy, it is a cumulative history of interactive processes (age, gender and disease specific) that are embedded in a child's developmental organization.

Clinical Implications:  The early recognition and incorporation of an FA-specific developmental framework into a treatment plan is essential and sets the stage for an effective medical care and the eventual transition from paediatric to adult care.

Capsule Summary:  This study represents a first attempt to provide an integrated developmental framework to explain the onset, development and maintenance of FA-related cognitions, emotions and behaviour.

This is probably an article that I'd take with me to any mental health professional who was going to treat a child/adolescent with a history of anaphylaxis.  It's one of the few on the subject that explores how FA reaches into every aspect of life-- and how some of those changes are ADAPTIVE, not "maladaptive" in nature, no matter how much they may resemble Generalized Anxiety Disorder or even AvPD or another Cluster C personality disorder.  When the danger is real, and hidden/invisible to others, AND requires the cooperation of those others, suddenly even fairly high baseline levels of anxiety seem downright reasonable. 

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It's probably no secret that social adjustment issues are HUGE for kids with a severe rxn hx or multiple food allergies during adolscence.  I'm trying to find out if there is a way to tease apart which is pathology and which is, at its heart, basically adaptive if far from normative.

http://lib.bioinfo.pl/pmid:11321630


That's a whole slew of interesting articles-- haven't been through them all at the moment.

Why am I curious about this all of a sudden?

Well-- NoQuote and no-peek for DD, please:

[spoiler]I'm concerned by some issues lately in my teen, who seems to have tangled with a peer who has NPD.  This was a perfect collision in some ways-- that is, ying-yang.  There was significant, protracted emotional abuse involved, and directed at my child.   When I looked more closely, I realized that my child doesn't just fit the mold of "socially-prescribed perfectionist" which would make a certain amount of sense in light of her FA, history, and her cognitive abilities, but she actually seems to meet most of the criteria for a cluster C personality disorder at this point in time.  Yes, horror is pretty much the best term that I have to describe this turn of events for me personally.

How much of that is PTSD?  How much is normal and adaptive-- FOR HER?  I have no idea.  But I want to have some idea how ot address that with a mental health professional, because heaven knows our allergist will NOT NOT NOT be pleased with someone that damages adaptive constructs like trusting her own perceptions (she has frequently had grade IV/V reactions without cutaneous symptoms) and using her anxiety as a personal early warning and avoidance system (she's also demonstrably aerosol sensitive).

On the other hand, it's also clear that some of the perfectionistic beliefs and social anxiety are related to the injuries she's sustained at the hands of this other peer...

but I mention this because it seems to me that MOST of our kids have characteristics that make them incredibly vulnerable and attractive to narcissistic individuals-- they are selfless, submissive/placating, socially easy-going, and prone to anxiety, as well as well-accustomed to being told that they are "crazy/paranoid/too sensitive."  This makes for a cocktail in which such a person can very slowly turn up the heat on that kind of abusive behavior to completely toxic levels while still pretending to be "friends" with them.  That's bad news.



[/spoiler]


Anyway.

So I'm trying to tease a few things apart, or at least have some things to share with our allergist/other professionals.

[twinturbo]

Ah, maybe it's different with male children. Mine tend to think very dude, hold my beer and watch this.

[hurt]

I'm going to have more to say about this in a couple of months, but having an allergist state in my dd's chart that my anxiety needs to be addressed by a professional has been extremely hurtful and damaging.  Yes, I know she passed the challenge, but the hives, itchy tongue, throat clearing, and eye swelling might warrant my insistence on having the proper paperwork and epi kept at school, don't you think?

(Personally identifying info has been edited at the request of the original author of this post.)

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{shudders}

Wow.  I'm so glad that we have such solid support from our allergist on this front.    I seriously cannot imagine being told that this was in my head.   

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http://www.highbeam.com/doc/1G1-314442881.html?key=01-42160D517E1B156D170E00170E6F4B36254D35463B78700E730E0B60641A617F1371193F


The psychosocial impact of life-threatening childhood food allergies.(Report)
Pediatric Nursing
November 1, 2012 | Broome-Stone, S. Brantlee


This is actually a surprisingly good article. 

[hurt]

{shudders}

Wow.  I'm so glad that we have such solid support from our allergist on this front.    I seriously cannot imagine being told that this was in my head.   

The weird part is that the chart doesn't seem to indicate that she thinks the symptoms are in my head, but that they are not concerning because dd PASSED the OFC and that is the GOLD standard ... the symptoms are leftover skin reactivity or probably due to something else like GERD ... so I am being anxious for worrying about them.   

Anyway, I don't want to take over this thread with this, but the topic of allergies and anxiety should be approached in a careful and empathetic manner.

[Macabre]

hurt that is amazing.  Really.  And it's amazing from several points--obviously a safety one but also if only from the point that having avoided an allergen for sooooo long, you'd think your allergist would have some empathy of what it's like to not avoid.  I mean that in and of itself is a huge thing. But then to have symptoms that are typical allergy symptoms to boot--why would an allergist not be more understanding?

I'm really sorry.  That's horrible.