FAACT's Roundtable

Ep. 290: After an Allergic Reaction: An Allergist & Psychologist Discuss Recovery

• Season 5 • Episode 290

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An allergic reaction may end when you leave the emergency room, but the recovery journey is often just beginning. Questions about medical follow-up, renewed confidence, and managing the fear and anxiety that can linger afterward are common for both patients and caregivers. In this episode, FAACT Medical Advisory Board member, Dr. Manisha Relan, and psychologist, Dr. Amanda Whitehouse, explore the medical and emotional aspects of recovery - sharing practical strategies to help families move forward with greater confidence after an allergic reaction. 

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Sponsored by: ARS Pharma

Thanks for listening! FAACT invites you to discover more exciting food allergy resources at FoodAllergyAwareness.org!

Caroline: Welcome to FAACT's Roundtable, a podcast dedicated

Caroline: to navigating life with food allergies across the lifespan. Presented in a welcoming format with interviews

Caroline: and open discussions, each episode will explore

Caroline: a specific topic, leaving you with the facts to know or use. Information presented via this podcast is educational and not intended to provide individual medical advice.

Caroline: Please consult with your personal board-certified allergist or healthcare providers for advice specific to your situation.

Hi everyone, I'm Caroline Moassessi and I am your host for the FAACT Roundtable podcast.

Caroline: I am a food allergy parent and

Caroline: advocate and the founder of the Grateful Foodie Blog.

And I am FAACT's Vice President of Community Relations.

Before we start today's podcast, I just want to pause for just a moment to say thank you to ARS Pharma for being a kind sponsor of FAACT's roundtable podcast.

And please note that today's guest was not sponsored or paid by ARS Pharma to participate in this specific podcast.

Caroline: Imagine this.

Caroline: You're sitting in the emergency room with

Caroline: your child after an allergic reaction.

Caroline: Thankfully, they recognized the symptoms, used their

Caroline: epinephrine, and got the emergency care they needed.

Caroline: The immediate crisis has passed, but now what?

Caroline: As you're preparing to head home, the questions start flooding in.

Caroline: Do you need a new epinephrine prescription?

Caroline: Should you schedule a follow up with your allergist? How do you process everything that just happened?

Caroline: And perhaps most importantly, how do you help your child and yourself regain confidence when an activity that once felt safe suddenly does not? Recovery from an allergic reaction involves more than physical healing.

Caroline: It can leave patients and caregivers navigating

Caroline: fear, anxiety,

uncertainty, and a host of practical next steps.

To help us explore recovery from both the medical and emotional perspectives, we're joined by allergist and FAACT Medical Advisory Board member Dr. Manisha Relan and psychologist Dr. Amanda Whitehouse. Together they will share insights and strategies for moving forward with confidence after an allergic reaction.

Caroline: Welcome back, Dr. Relan and Dr. Whitehouse to FAACT's Roundtable podcast. This is so exciting today because we have both of you with us to give your professional perspectives to something that we talk about individually to to a psychologist and a mental health care professional or to the doctor, but never both of you together.

So this is very exciting. Welcome.

Dr. Relan: Thank you. We're really excited to be here together.

Dr. Whitehouse: Yeah, thanks for having us. This is a great idea.

Caroline: That's wonderful. I'm so glad you're here.

Before we explore what happens after an allergic reaction, let's get to know our guests. I know you will, but our listeners may not fully yet so let's dig right into that.

Can each of you share a little bit of your background and the experience that led you to work in the food allergy community?

So let's start with Dr. Relan.

Dr. Relan: Yes.

Dr. Whitehouse: Hi.

Dr. Relan: I'm a pediatric allergist by training in clinical practice.

This is my 12th year.

And I would say food allergies is part of is part of being a pediatric allergist. It's our bread and butter. I have a nutrition and food science background and training,

and then I have a lot of my own journey that kind of adds to my own personal experience.

Caroline: And Dr. Whitehouse.

Dr. Whitehouse: So I am a licensed psychologist and I'm also a food allergy mom.

So I've been doing work specializing with families, managing allergies for about 14 years now and living with it in my own house, too.

Caroline: Let's put our listeners into a very real situation. And here it is. Your child has just experienced an allergic reaction and they did everything right. They recognized the symptoms, they used epinephrine and received emergency care.

You're in the ER and now the doctor says you're ready to go home.

Relief is setting in, but there's so many questions still.

So, Dr. Relan, what should families be thinking about before they walk out the ER doors? What medical follow up is needed? Prescriptions or conversations should be on their checklist?

Dr. Relan: Well, I think sometimes you may not have this in the forefront, but the most important thing is making sure that there's another epinephrine device available because occasionally, and this is rare, but it does happen as a biphasic reaction.

So just being prepared for an unexpected and that's like the worst case outcome, I would say, to be ready for. And so always having another epinephrine device that's unexpired and readily available that you will not hesitate to use as well.

And then after that, I think it's just taking care of your immediate urgent needs. So if it's nighttime, you get release at 2:00am, you know, just taking care of you, it's okay to make yourself a priority as a caregiver because you cannot show up tomorrow or the next day for both your child,

yourself personally and then and then as a parent with me on the other line, I think just sending us a message in the morning, a portal is more readily available.

Sometimes that's easier. You can do it right in the moment so you don't forget and you get that off your mental mind load because there's a lot of mental load unpack after such an experience.

We want to Hear about it on my side, I want to hear about it. If a child had an allergic reaction, especially a pre existing known allergic condition for which epinephrine was prescribed by myself or my office.

So we'd want to hear from you and we would schedule a follow up, like we would just try to check in with you, process what happened,

go over the steps, go over,

you know, where could we improve for the next future. I tell people we can't live in the past, but we can learn from the past.

Caroline: That's great advice. And so I have another question for you that I've heard from people in my community.

So I used to lead the food allergy support group here in town and a child had a first time reaction. They were seven years old and the parent just didn't know what to do next.

So they haven't established with an allergist yet. You know, again, first time reaction in the er, the ER doc gave them a prescription for epinephrine and then they were just in this full fledged panic.

What would you suggest?

We suggest, I guess as supporters that that family should do at that point

Dr. Relan: I would suggest contacting the primary care provider because they, they do have an established relationship with someone in the community that can guide them.

And I would subsequently ask for a referral to an allergist because I think any allergic reaction warrants at least one conversation to break it down, to go over it even if, and this happens full disclosure to me as well, where I don't find the trigger in more so in adults than children I would say.

But allergic reactions can happen and we are so investigating and therefore it's even more important to be established with an allergist if we don't know the cause.

Caroline: Really good advice, thank you again. Someone actually just messaged me a few months ago about the same thing. They had an allergic reaction, they knew I lived in town and I have kids with food allergies and they got on the wait list to get into the allergist but didn't know what to do and they were avoiding all sorts of foods.

And so I suggested they go back to their pediatrician but visit FAACT's website,

get some information,

get a feel for it because they were restricting their diets and so I just wanted to make sure they had a little information. But honestly it's just really important to hear what do we suggest when this happens.

And so now let's turn to Dr. Whitehouse because while those physical systems might be resolving, the emotional impact is just often beginning.

Caroline: Right.

Caroline: How can families Start processing the fear, the uncertainty, the loss of confidence. I mean, if you can just kind of go into all the things that you see happening and then what should happen next or what could happen next.

Dr. Whitehouse: Definitely. It's so much to process. It's such a complex experience.

And I think it's just really important, first of all, to know that that's normal.

It's really normal to be shook up and to of feel thrown off. And Dr. Relan kind of did my job for me and touched on that. Like, it's okay to take care of yourself and just do what you need to do to get back to a sense of safety.

And I think that everyone has a different definition of what that means, but especially if we're dealing with kids, I think it's a lot of what we know comforts them and comforts us.

So I know for myself, when my son has had a reaction, I feel better when I can stay close to him for a while and we can kind of stay home or we can, you know, maybe dial our routine back a little.

If there was something, you know, that was a little bit of a stretch that we were going to do. So not to hide away from the world, but also to know that it's okay to.

To kind of dial back what we need to do to feel safe for the short term, obviously, and I know we'll get to that. If that becomes a long term coping strategy, that's a different story.

But a day or two after you've had a reaction, you know, we expect ourselves to just bounce back immediately and return to life like everything is normal and our bodies and our nervous systems don't respond that way.

You know, we have to. We have to eat dinner the same night, or we have to eat breakfast the next day. And we have to just make sure that we can do that in a way that feels safe, whatever that means for us.

The other thing I say is really to encourage them to not try to fix those feelings immediately. I think we have difficulty as a whole sitting with uncomfortable feelings, especially when they are our children's.

I think the opposite is what's actually helpful, which is acknowledging them, recognizing them. You know,

Dr. Relan talked about if there was some fear as hesitation to use the epinephrine.

We need to acknowledge that fear and talk about it so that we can then eventually, maybe not right away, but eventually, we want to work on how that fear compromised our safety.

If we delayed using the medication that we need and what we can do to work on that. If we just avoid it and shove it under the rug, then we're going to miss important things that we can learn from the experience.

So we want to find support for ourselves as caregivers and we want to support our children through that as well by acknowledging the feelings that they're having and making sure that they know that we're comfortable and it's okay to feel them and it's normal to feel them.

Caroline: Can we talk just for a moment about the ER from the perspective of an adult?

Any tips on how to regulate? My son had his first ER visit when he was 24. He was home from college. We were at friend's house and he had an allergic reaction from their food.

He took his epinephrine, we went to the er and even though the allergic reaction had resolved with the epinephrine, he started developing hives in the er.

So the ER doctor said, nope, I need you to stay, we're going to observe you. I actually believe that those hives are from your emotions and that your emotions are very high.

So we're just going to have you stay a little longer for observation.

So at that moment I knew that if I looked concerned or if I was a little amplified,

then that was going to impact him. So I went to the bathroom,

tried to self regulate and came back out. But honestly, I really was at a bit of a loss of what to do.

So I would love to hear your advice for adults or friends or whoever else is in the ER on how to just step back,

how to regulate and then what to do when you see them.

The patient getting very emotional.

Dr. Whitehouse: Yeah, it's really tricky because it's so intense and it's so important to distinguish between that. But that's a great example of how real the physical signs of anxiety can be there.

It's real. It's not just your head, it's not just in your feelings. So it sounds like you had a great doctor that was able to acknowledge that but not dismiss it, to treat it like something we really need to watch carefully.

We can't always be so lucky. But thank goodness for doctors that recognize the importance of that. And it sounds like you did all the right things. But I, I think what people forget is how sensory based our nervous systems are.

So in terms of reestablishing some sense of safety, even when something genuinely dangerous has happened and when you're in,

you know, an environment that can feel scary and chaotic is coming back to what gives the body safety signals and that is contact and closeness with trusted people, that's soothing things.

So like, we all know how it is when you're in the ER and you're freezing, you've been waiting, and some sweet nurse just, like, brings you a blanket or brings you something refreshing to drink.

So some of those things that give you just soothing, nice, comfortable, familiar experiences can be helpful. And as you said, it's easier said than done. But as you said, keeping yourself as calm as possible helps to soothe our children.

So again, that doesn't mean just ignoring how we're feeling. They can feel it if we're upset. But kind of acknowledging to them, I know we're both feeling a little scared right now, or whatever the right words might be for how you're feeling.

Here's what we can do. Let's do this together. Let's watch a familiar show on my phone. Let's hold hands, let's snuggle up under the blanket. Let's breathe. Let's have, you know, a treat or a cup of tea or a drink, whatever it might be that you can do together.

And you're. You're saying what you're doing to cope and get yourself calm rather than just pretending you're calm on the outside, when inside you're not.

Dr. Relan: As a provider, there's two things, because when I am treating anaphylaxis,

I too, have to maintain calmness, right? Like, I may not internally be feeling calm, because also on the receiving end, and a very important, critical moment by moment situation.

And for me, I find that grounding my physical body really helps. And so I bring attention to my physical cues.

And I actually like to lean my back against the wall or against a bench or chair.

And I don't know what it is about the nervous system, but that way, kind of like, I don't have to worry about things behind me, and I'm just focused on what's in front of me.

And so for my personal body, this helps. And the second thing I do is attention to my breath. I'm a big believer. My patients know we do 4, 7, 8, breathing in the office as a part of my teaching for especially in asthma situations with breath work.

But I do a quick four, seven.

It's 19 seconds, I think, if I'm doing my math correctly.

And it's just like a great way to just calm me down, focus on what's in front of me.

Caroline: That's really critical. Think about it. We always focus on the patient and the caregiver or, you know, whoever's in the room with them. But you're right, the physician really leads and sets the stage and creates the whole environment.

You are absolutely amazing. I'm so happy you shared that, because that really is important.

So now let's turn our attention to after you get home. So now let's look at. It's one month later. Okay, so, Dr. Raylan, from your perspective as an allergist, where would you like your patient to be in terms of their medical care,

their mental health care?

And let's say they're reporting increased anxiety, and maybe there is now a newfound fear of eating or even eating out. That actually happened to my son after that ER Visit.

He did not want to eat out, and he was well into his 20s, and he was in grad school, and I thought he was just fine.

Dr. Relan: There's a healthy balance for anxiety and fears. Like, we need them to survive. It's normal. We need to acknowledge that this, like, protects us.

And certain situations that you don't feel control over, it's okay to say it's not for me right now. There's two things I always tell my patients. We focus on what we can control,

and so we always try to bring a situation. I bring hypothetical situations. I say, walk me through what you would do here,

and let's see how I would intervene and suggest that you walk through the situation.

So one thing is, like, what can we control? And the other thing is,

how important is it? What is the situation that you're saying no to? You know, saying no to a friend that's offering you a drink is very different than saying no to going to a party that you want to go to.

Where can we navigate and find the balance where you can attend, but be in control of what? Eating,

Right. So, like, you can go.

You can bring your safe food. I always like to backtrack to what happened. And I like to tell them that we're all humans.

We can make mistakes.

We need to acknowledge that we make mistakes. We need to acknowledge there may have been near misses in the past,

and we still got through them.

And then I tell them that we take it one step at a time, and one month may be too close to the event to kind of really emotionally recover still.

And so it's still a work in progress, and we build on baby steps. Like any other form of anxiety.

We may not be ready to go to a restaurant, but maybe we can walk into the restaurant and just get a beverage and then walk out and not actually have eaten.

But, like, you put yourself in the place that gave you fear,

and you went through a contact situation, right? Like, you got a.

A glass of water or you bought a beverage, but you actually left and didn't eat anything.

You still exposed yourself to what made you scared without having to go through the exact steps of what may have led to the reaction.

Caroline: Yes.

Caroline: I mean, as you're saying this, it's all going through my head going, I could see that value. Right. Just showing them it's okay. It's okay to go back to a friend's house.

It's okay to go back to their house,

you know, where the reaction happened. Another question, from that allergy viewpoint,

would you ever do retesting?

Like, would there be this question of maybe there's a new allergen or anything like that? Would that come up?

Dr. Relan: Yeah. So like immediately after, like the first few days after, when someone contacts me, we want to try to figure out what exactly happened. So I do make them go through their steps again to make sure we know exactly what triggered the reaction.

I think that doing those exposure based therapies, like walking through the grocery store aisle or the allergen that you're allergic to, just walking past it, not touching it, is also a form of exposure therapy.

Therapy. Because there's people that won't walk through certain parts of the store, it causes them so much anxiety. And so I'm like, this is a closed container. You're not touching it.

And so sometimes it just starts with the baby steps and then leads up to it. But to answer your point, absolutely. We want to make sure we've identified what caused the reaction.

And based on different ages, the answers might be different things. Like when we're feeding a baby,

we know exactly what we're feeding the baby and we can kind of figure out what may have caused a reaction or process of elimination.

With a child that has a pre existing allergy and the contact happened or the ingestion happened, usually we can figure it out with an adult is where sometimes it's tricky is with the idiopathic anaphylaxis and certainly with like mastocytosis and other conditions.

There's also hereditary tryptasemia,

if I got it right, alpha tryptasemia. So ATZ abbreviation. So like there's tricky spaces where figuring it out may need an allergist and may need some lab work or some more in depth conversation and approach.

Dr. Whitehouse: Right.

Caroline: So really, all in all, you must follow up with that allergist to get that medical side going. And so now let's turn to Dr. Whitehouse and then your perspective.

Dr. Whitehouse: Well, Dr. Relan already covered that so beautifully. You picked the Perfect position to join us for this episode. I mean I think the, the point that she emphasizes that this is a gradual process, right?

We, we think of it in very black and white like oh, it's a month later. I should be back to normal right now. But normal is constantly changing for us based on our experiences.

There's no magic timeline, you know, there's no checklist of well, I should be doing this by this point. The worry and the fear, I try to be really careful about the way we talk about it because they are normal and they're adaptive and it's, it's your body and your nervous system trying to protect you from something that is genuinely dangerous or threatening for you.

The line that I use to help us try to distinguish between what's adaptive and then what becomes problematic is to be careful, not fearful.

So those things are normal and they're adaptive, but the anxiety and the fear aren't helpful. And I want to be careful not to like prescribe worry to people like now that anxiety is like it's protecting you but really the anxiety is the part that goes beyond what's productive, what's actually protecting us.

Right. So I'm never eating at a restaurant again. That's the anxiety. What Dr. Relan described is the caution, right. The precautions that we're using.

I'm not ready for this yet. That's some self awareness. I'm going to do this in a gradual way that is supportive of returning to this and that's being careful and being cautious in a self aware way.

That's not letting the anxiety shrink your world or restrict your world. You know, I really try to help people label it. Is this thing that I want to avoid or this behavior that I want to do, is it caution or is it anxiety?

If it's anxiety then that's going beyond what's necessary to keep yourself safe or beyond again what's making you feel like, well now my world is shrinking. I just have to get smaller and smaller to feel safe.

So we do want to gradually expand that and you know, the way that Dr. Relan described it is perfect. The part that I would add as a psychologist, which I know she implying in this is that we have to do it in a supported way.

So we do those gradual steps but we do that with supports that keep us from being re traumatized and instead give us so much safety in that experience that we do feel comfortable enough gradually and safely,

little step by step moving forward. So that's safe. People,

you know, as she described, like things that are a slight step forward, but not too much to make it overwhelming and push us back into.

I just want to, you know, run away and go home.

So that takes a lot of self awareness. And as parents, it can be even harder as we're trying to gauge how our children are feeling and what's too much for them, plus what's too much for us.

And then the combination together can get really tricky. You know, again, it's about a lot of self awareness in that and moving forward. Without these black and white definitions of it's time, we are not back to normal yet.

This should be gone by now. We just have to adapt as we go along.

Caroline: I like how you're discussing about those black and white definitions because I think that's where we go to naturally. It's like, oh, well, it's. It's been a month, it's been a few weeks, it's been a few months.

Like, what's wrong with you? Something's not right.

Dr. Whitehouse: And.

Caroline: And we just assume like, no, everyone has to be healed immediately.

You know, and often I hear, you know, from that support group, you know, realm and background, you know, know parents really struggling and thinking that they can't get help. So can you talk to that, just briefly?

Dr. Relan: Yes.

Dr. Whitehouse: People can help. People want to help. There are resources out there. There are amazing accounts like, follow Dr. Relan's account. She gives such a calm way of sharing good, helpful, trustworthy medical information.

And I think we need information to balance out a lot of what we hear.

In some of the extreme cases, or the friend that we know who had something really scary or really rare happen to them.

Anxiety in the moment isn't calmed by, well, here's the factual information about what you're experiencing. But long term, when we can get calm again, we can take that information in, we can integrate it.

That's what helps us to balance it out. Our doctors can stay calm like Dr. Relan described, even though it's hard because they have this wealth of experience,

knowing they will get through this. I've seen patients recover. We don't have the benefit of all that experience because we only have our experience and the handful of the people we know or whatever we read on the Internet.

So borrowing that from them is a really great way to kind of develop that experiential knowledge and trustworthy information.

And then therapy can be really helpful for parents and for kids.

So the thing that I say a lot is food allergy experience is really great. And for our population of people after something like what we're Talking about that really is a traumatic event.

What I suggest is finding someone who's trauma informed. So a trauma informed therapist near you.

Most people are surprised to learn that all therapists do not receive training in trauma care.

So that would be the number one question that I would ask because that person would then understand,

even if they don't fully understand food allergies, they would know if you're showing signs of trauma and how to approach that without exacerbating it. A lot of anxiety work is challenging the anxiety, but when it's trauma symptoms that really can make the problem worse and not better.

Caroline: Absolute great and stunning information.

And our time is up. This went so fast.

So before we say goodbye, is there anything else you want our listeners to hear from you? And we'll start with you, Dr. Relan.

Dr. Relan: Yeah, I just wanted to say thank you so much, Dr. Whitehead, House, for the the call out. I try to maintain a very calm demeanor because anxiety is real and parenting is hard, then parenting just in general baseline is hard.

And then you add a chronic invisible disease that has so much emotion and mainstream media has just like not done a great job of displaying and really promoting it correctly.

I think that things are changing, thankfully. But then you add social media and things can heighten some of those emotions.

So having a place to go to that can like bring you some soothing calmness. And for me, I think first and foremost, taking care of your immediate needs.

Sleep. And then don't forget the power of journaling.

I think writing down, drawing,

like letting out some of those emotions in different ways can be very helpful because as a caregiver,

especially if you were there to witness the event,

there's also a little bit of blame that comes in and it's really hard to separate and say that I didn't do this on purpose.

Something happened by accident or a loved one that was babysitting, something happened and. Or in a daycare setting or in a school setting, like, whatever, but like no one intentionally meant to,

I hope do this. And so it is really hard to not take the blame and say, I wish I wasn't working and I should have been a full time caregiver to my child.

Or, you know, like just the what ifs and the.

Yeah,

so take a pause. We can't control everything.

Focus what's on your control. Use really good communication and take care of yourself.

Thank you.

Caroline: You're so wise. I just adore you. And Dr. Whitehouse, that was perfect.

Dr. Whitehouse: I think acknowledging that parental guilt and shame is huge and I'll touch On one of the ways that I see that showing up and kind of in the way that Dr.

Relan talking about is a lot of children, after they go through a process like this, will talk about it over and over and over again. If we don't deal with our own guilt and shame and again expand our capacity to be with them in their tough emotions, we can really accidentally shut down their natural processing experience.

So prepare yourself for your child to say over and over again, hey, Mommy, remember that one, you know, day at the park or whatever it was, and to tell the story over and over again, even sometimes when with details that don't seem like the important part or a perspective of it that's different from yours.

This is how kids make sense of things. So for them and for yourself, be willing to talk through it, be willing to acknowledge and normalize the feelings. What we're looking for is not the absence of fear or worry, it's acknowledgement of it and working with it and then building trust in ourselves,

in our medications, in our providers, in each other and the safety net that we've built around us. So basically focusing on, in the end, after we've acknowledged the feelings, focusing on bringing it back to what happened, what brought us back to safety, what worked, what did we do well,

and what do we know we are capable of moving forward.

Caroline: Incredible. Dr. Whitehouse, I am also a huge fan of yours,

so thank you and listeners. I will have in the show Notes link so you can follow both of these amazing women here. And Dr. Whitehouse actually has a new book out too,

so I will make sure I'll put the link to that in as well.

And thank you again to both of you. Really appreciate your time. You're so busy, but this information's so critical. I mean, I wish I had this 20 years ago when I was, you know, with my children and having the support group and everything.

And it's just so exciting that we just are getting more information and we're sharing and we're using technology like podcasts and everything to share all this data. So thank you both very much for your time.

Dr. Whitehouse: Thank you so much for having this conversation. I think it's a really important one.

Dr. Relan: And you know what? The important thing is to keep having the conversation for as long as you need until you're comfortable with it, too.

Caroline: Absolutely. Thank you to both.

Caroline: Before we say goodbye today, I just want to pause for one more moment to say thank you to ARS Pharma for being a kind sponsor of FSACT's roundtable podcast.

And please note, today's guest was not sponsored by or paid by ARS Pharma to participate in this specific podcast.

Caroline: Thank you for listening to FAACT's Roundtable Podcast.

Caroline: Stay tuned for future episodes coming soon.

Caroline: Please subscribe, leave a review and listen to our podcast on Pandora, Apple Podcasts,

Caroline: Spotify, Google Podcasts, iHeartRadio and Stitcher. Have a great day and always be

Caroline: kind to one another.