Ep. 298: Avoiding Food Allergy Burnout

Managing food allergies is a marathon—and sometimes, we simply get tired. The constant planning, vigilance, and decision-making can leave patients and caregivers feeling overwhelmed and emotionally drained. So, how do we recognize food allergy burnout before it takes over—and, more importantly, how do we recharge?

Psychologist and researcher, Dr. Nancy Rotter, joins us to explore why burnout happens and share practical strategies to help you reset, recharge, and move forward with greater confidence.

Resources to keep you in the know:

• Psychology Today: Find a Therapist
• FAACT's Behavioral Health Center

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

Transcript

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Caroline: Welcome to FAACT's Roundtable, a podcast dedicated to navigating life with food allergies across the lifespan. Presented in a welcoming format with interviews and open discussions,

each episode will explore a specific topic, leaving you with the FAACTS to know or use.

Information presented via this podcast is educational and not intended to provide individual medical advice.

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. I am a food allergy parent and advocate and the founder of the Grateful Foodie Blog.

And I am FAACTS Vice President of Community Relations.

Before we start today's very interesting conversation,

I just want to pause for just a moment to say thank you to DBV Technologies for being a very kind sponsor of FAACT's Roundtable Podcast.

Please note that today's guest was not sponsored by DBV or compensated in any way by the sponsor to participate in this specific podcast.

Caroline: Managing food allergies is a marathon, not a sprint. The daily planning, constant vigilance, and endless decision making can take a real emotional toll on patients, parents and caregivers. If you've ever felt exhausted, overwhelmed, or simply worn out, you're not alone.

Food allergy burnout is real.

The good news? Burnout does not have to be inevitable. Today we're joined by psychologist and researcher Dr. Nancy Rotter, director of Psychological Services at the Food Allergy Center,

Co-Director of the Integrated Primary Care Program at Massachusetts General, to help explore why burnout happens, how to recognize it, and practical strategies to help you recharge and thrive.

Welcome back, Nancy, to FAACT's Roundtable Podcast. We're always very happy to have you on with us because you bring us that real life practical solutions and you talk about that one area that we just always seem to need more and more information, especially as we go through

Dr. Rotter: different ages and stages.

Caroline: So thank you for being with us today.

Dr. Rotter: Happy to be here. Thanks for having me again.

Caroline: You're very welcome.

Before we dive into today's topic, we'd love for our listeners to get to know you a little better.

So can you share what drew you into the field of food allergy and tell us about the work you do today supporting patients and families, including research.

Dr. Rotter: Sounds good. Happy to do that.

So I was always interested in the intersection between medical issues and psychology.

And then early in my career I decided to expand my skills and experience from the more general clinical work I was doing with children by doing an advanced fellowship at Boston Children's Hospital, where I worked for several years.

And after That I accepted a position at Mass General hospital more than 20 years ago and I saw a variety of pediatric patients with a range of medical conditions. I had the opportunity at that time to work with several children who were coping with food allergies and was really compelled by the challenges that these children and families were managing on a daily basis.

And so when there was an opportunity that arose for me to join the newly established food Allergy center at MASS, I happily joined the team. Clinically, I provide therapy to children with food allergies and their caregivers who are coping with challenges related to their food allergies and often struggling with stress and anxiety.

I also support children with procedural anxiety about things like food challenges or other interventions such as oral immunotherapy or receiving injections for their allergies. I conduct quality improvement projects. That's the work I do in the research area.

And those are. Those projects are primarily related to child and caregiver anxiety.

I also supervise postdoctoral fellows who are interested in working in the area of food allergy.

Caroline: Saying you're busy would be an understatement. That is a lot. And I love that you work with fellows.

Dr. Rotter: That's fascinating.

Yeah. When we have psychology, postdoctoral fellows who are doing a specialty in pediatric psychology, so working in different areas of the overlap with medical and psychology, if they're interested in food allergy, they work with me for usually a half day a week, which is great for me and I think a nice experience for them as well.

Caroline: That's wonderful.

Let's just jump right in. Food allergy burnout is something many families experience, but they don't always recognize it. Why does it happen? And then what makes managing food allergy so emotionally demanding over time?

Not just in the beginning when you have that first diagnosis, but the long haul.

Dr. Rotter: It's a really good question and a really important thing to talk about. You know, I have to say, Caroline, I was really interested in thinking about the term burnout because burnout started as a concept back in the 70s by a psychologist who used it to describe severe physical and mental exhaustion that you saw in healthcare workers.

His name was Herbert Freudenberger.

And then another psychologist adapted it into a more rigorous clinical framework. Her name was Christina Mashlock and she established this widely used three dimensional model that involved emotional exhaustion, cynicism and reduced professional efficacy.

And that has continued to serve as the basis for thinking about occupational burnout. But I was really curious about how the term burnout came to apply to health conditions. And so what I learned in the research I did was that patient communities actually adopted the concept in a to the management of chronic illness.

Which really makes sense because chronic illness and chronic illness burnout is a state of mental, emotional and physical exhaustion caused by the constant demands of managing a long term health condition.

So that does also fit certainly with food allergy and what people manage who have food allergies or who are caring for someone with food allergies. And while that concept hasn't been extensively studied, I think that it is one that really resonates with patients.

And with respect to food allergies, the management of a chronic condition that impacts those with food allergies, it is a every day,

multiple times a day, maybe all day,

thinking about things related to food allergies. And that can certainly lead to anxiety or constant stress. Things like reading ingredient labels every time food is purchased, or asking questions at restaurants and social events, planning meals, carrying safe foods, always having emergency medicine like epinephrine available,

monitoring symptoms or worrying about accidental ingestions, and then things like educating teachers and families and friends about food allergies.

Having to engage in all of those things is really stressful. And I think it's important to think about,

when we discuss a chronic level of stress, about the physiological process that happens involving the nervous system. Chronic stress keeps the brain in a heightened state of fear. When this becomes a pattern, it's difficult to reduce anxiety,

even as small things are experienced as threats. So basically the system remains on high alert. That's because the amygdala, which is the brain's threat detector, becomes more sensitive.

And while the prefrontal cortex, which is the part of the brain that really helps with thinking clearly and helps to shift out of high alert, becomes less effective.

So that chronic exposure to anxiety threat keeps the amygdala working hard.

And that's what happens physiologically to those who are experiencing chronic stress or burnout from food allergies. The good news is that research indicates that brain possesses neuroplasticity,

which means that with practice it can rewire, develop new pathways,

and learn that stress can be temporary. And that's key. One of the challenges with food allergies is that and with any chronic condition or any burnout condition, that someone may not be aware of the burnout because it becomes a very familiar and chronic state.

Caroline: One of the hardest parts about burnout is that it can just sneak up on us. So what are some of the early signs that a parent or caregiver may be experiencing?

And how can those signs look different in teens or adults who are Managing the food allergies on their own.

Dr. Rotter: As I mentioned earlier, I think one of the reasons it's so difficult to identify burnout is that it does develop gradually, often, and it can become a very familiar mode of functioning and being in the world.

So it is understandable that that someone might not recognize that that's what they're experiencing. And I've been thinking a lot about how does stress and burnout look similar or different in caregivers and teens and adults.

And I really didn't come up with much that I thought was different.

I think that it's general themes and what I do think is probably different is that for each individual who experiences burnout related to food allergies, that their experience is different.

So that has been sort of my thinking about it as I've considered this and as I've witnessed it and some of the folks I've worked.

But generally people experiencing burnout may observe that they are feeling emotionally exhausted or experiencing a higher level of anxiety.

They might find that daily allergy management has become overwhelming.

They might even find that sometimes they're becoming less vigilant or maybe they're becoming excessively vigilant. So sometimes it's about the extremes.

They might notice increased frustration, resentment, or even hopelessness about living with a food allergy or manning a child's food allergy, such that it's hard to imagine in doing this going forward.

They may have difficulty concentrating allergy related tasks. They may feel guilty for wanting a break from managing the food allergy. And I'll just say, you know, it was really interesting during the pandemic.

It is the closest thing to a break from managing food allergies that I've witnessed in my career because everyone was in their house and so food was managed by the family in a more profound way.

They weren't eating at school, they weren't eating at friends houses or going to parties. And in some ways, and I did hear some families talk about how that felt like a little bit of a break.

There were other challenges. Accessing allergen free foods became challenging. But it was a really interesting observation.

They sometimes feel like they are constantly on alert. And that's what I've been talking about.

There's just this heightened sense of stress and anxiety. They might notice some sleep disturbance or fatigue from having to make so many decisions. And they might find that there's more conflict with family members over allergy precautions.

And although there may not be a specific signal or a clearly defined trigger, as I mentioned, I think this can happen gradually as the, you know, stress alarm, the amygdala continues to be going off and is chronic.

There are times I see specific triggers, and one example I wanted to share is that I have seen a lot of parents of children with toddlers who have multiple food allergies and may also perhaps have FPIs.

And the stress of doing things like adding new foods to a diet and not knowing when you're introducing a new food if it's going to cause a reaction, particularly, I think the FPICE reactions, which can be delayed, worry about not only just food, about reactions, but also about keeping the safe foods in the diet.

Maybe ones that have been passed through an oral food challenge or once they've introduced at home. I've seen that become a very significant burden and lead to what I would say is the equivalent of food allergy burnout in that situation.

But there are many possible triggers.

And again,

my observation is often it's more the chronicity that builds up over time.

Caroline: Well, you mentioned stress and anxiety, and as you were mentioning it, I was thinking, you know what I think even for myself, when I've felt like, oh, I'm just so burned out, oh, I don't want to go to another party.

You know, when my kids were little and managing food, and when you just mentioned stress and anxiety, it struck me that maybe I was compartmentalizing a little bit. And instead of saying, hey, I'm just feeling stressed and anxious about this, let me deal with that.

Instead, I'm like, I'm just exhausted of this. And I think it's so fascinating that you're now building this link so we can better identify what's actually going on inside.

Dr. Rotter: I think, you know, sort of as time has gone on and science has advanced, we understand things more in a more detailed and nuanced way.

But things remain challenging despite our knowledge and the advancement of research.

Caroline: They really do. But it's just so beautiful, though, that we're getting this advancement and we're having this information. I mean, my son just turned 28,

and so I'm thinking back to this burnout when he was just this cute little bug and we're navigating these parties. And so it is beautiful that we have people like you now and all sorts of information, but it really is fascinating that I shouldn't even say fascinating.

It's really, like, wonderful that we are getting all the support and information and we are having these conversations to identify, hey,

you're actually feeling stressed, you're actually feeling anxious. We can deal with this.

We can approach this. Good news is right that the burnout doesn't have to be permanent.

So what are some practical and realistic strategies that parents, caregivers, and again individuals with food allergies can tap into to recharge, to build up resilience and just maybe even try to prevent that burnout feeling?

Dr. Rotter: As I noted earlier, the brain has neuroplasticity and can be rewired with practice at developing new pathways.

And learn that stress can be temporary so that your nervous system learns that it doesn't have to be in this constant state of stress. Ideally, and when possible,

developing regular practice to prevent burnout is really the gold standard and also very difficult to achieve.

I do like to think about it as comparable or similar to what people do to try and strengthen muscles by lifting weights to be fit or for health.

The regular practice of skills that build a calming response, that's that rest and digest part of the nervous system, the autonomic nervous system. So we're talking about the parasympathetic nervous system.

The sympathetic nervous system is the one that's responsible for really firing up the amygdala. It's the fear response. And that's what we're talking about gets very activated. And so how do we engage or how do we consciously work to really develop the parasympathetic, the quieting down, the calming part of the brain and the parts of the prefrontal cortex that really help with processing emotions and quieting the fear centers down like the amygdala is really what we're trying

to do.

So the idea of regular practice is again kind of the gold standard. But I think what's really important is that people are aware that the signs of burnout so that they can identify them as early as possible and really then work towards building up some skills.

So certainly maximizing self care, which is intentionally taking actions to maintain one's well being, is about meeting one's basic needs and protecting one's health to enable individuals to function well.

And each person needs to find what works for them. But they kind of fall into different domains. So one domain is physical. That's things like getting sufficient sleep, eating well, moving your body, getting regular medical care.

Then there's mental care that would be something like mindfulness, maybe trying a new mindfulness app or learning something new, listening to music.

And then there's the emotional component, really allowing yourself to feel emotions.

Journaling is a very helpful thing because actually writing engages the prefrontal cortex. So writing is very helpful for retraining, essentially the nervous system,

doing social things. So social is another domain. Spending time with friends or family,

people that are supportive. For people who find that being spiritual is meaningful to them, that's an important component too. And that can be praying and meditating, but that can also be spending time in nature or connecting with one's values.

And I like to add creative, although it does kind of cut across these things. But I think that's a very helpful piece too.

Writing, drawing, cooking, gardening, taking a class or an online tutorial, learning a new dance. All of these things are helpful as part of self care.

I also want to just point out a couple of things that are brief, quick things that people can do daily that can be helpful so is to find a daily mindfulness practice.

I really like the concept of glimmers, and it's one that I actually learned about from my colleague Amanda Whitehouse, who's a psychologist who sees a lot of patients with food allergies and parents.

And glimmers are tiny, fleeting micro moments of joy, peace, safety. And they signal safety to your nervous system. They can be small sensory cues like noticing how the warm sun feels on your skin or how a flower smells,

or what it feels like to pet your dog's fur and what it feels like on your fingers.

And these are these glimmers really help re engage that parasympathetic nervous system as well.

Another one I like is gratitude, which is really the act of intentionally recognizing and appreciating positive aspects of your life.

It actively rewires the brain to boost your mood, improve sleep, and reduce stress. And trying to have a habit of doing this, as I mentioned, these are good daily things that can be short but be.

But can be used frequently.

So for many people having a daily gratitude practice, like writing three things down that they're grateful about before going to bed. And they can be big things like your child just graduated from high school, or they can be tiny things that you had the best iced latte of your life today.

So just having that as a practice can be a very helpful thing.

Additionally,

things like paying attention to things that might add additional stress in limiting these,

for example,

it is very common and understandable and important to get as much information as you can. As a parent of a child with food allergies. Sometimes that leads to accessing information from all different places, and sometimes that can lead to doom scrolling on social media.

And that can add extra anxiety and stress. And so really thinking about kind of managing that.

Sometimes it's thinking about what social media sites or influencers do you want to follow? And trying to stick with people who really are providing science based information.

Sometimes it's going on a social media diet and limiting it on a daily basis.

Another way to pay attention to things that might be causing additional stress is to really think about, is this something I really need to do? So if you're in the habit of baking allergen free cupcakes that look like the cupcakes that are at the child's friend's birthday party,

that's a lot of work. And it may be that on some occasions that you can find an easier alternative that your child will like equally well.

A type of candy that they may not usually have, but that is safe for them. And so thinking about how to reduce some of the things in one's life that cause additional stress,

setting boundaries when possible is also important.

Allowing yourself to take a pass on things. Your child's going on a field trip, but it's a morning field trip. There's no food involved.

You could turn down chaperoning for that potentially. And so thinking about what are some ways to limit things so that it feels more manageable.

And then finally, I just want to say that it's really important to ask for or seek support.

And that can look many different ways. If it is hard to manage food allergies on your own, or as a parent of a child with food allergies, sharing responsibilities when you can with a partner or family member, if that is a possibility,

connecting with other people who are managing similar things, potentially through food allergy support groups, and certainly seeking mental health support if symptoms of anxiety, stress or depression persist or become more severe is really important.

Caroline: This is amazing. What a practical list.

Caroline: I was actually taking notes.

Caroline: These are so practical. And honestly, as I was listening to the list, my own stress levels were dropping because you were providing all these solutions which are just again,

so amazing. Now, you mentioned regular practice.

So are you talking daily?

Every few days?

Is there a particular rhythm? You did mention, like the daily glimmers and daily gratitude, which I think are fun. I do daily gratitude myself. Love the glimmers. That's incredible.

But how do you define regular practice?

Dr. Rotter: Right. You know, again,

some of it has to do with each individual and what they're capable of.

I think having sort of overriding goals like physical health, sleep, because sleep isn't gonna be,

you know, exactly as you wanted every night. But I think having sort of overriding goals and sometimes just setting a goal, like this week, I really. Or for the next month, I really wanna focus on Reducing my social media intake.

So you can't do all of these things all at once.

But I think, you know, regular practice, the more one practices something, the more the better they regulate. And so that's why I really like the small things like the glimmers,

like the daily gratitude practice. But it could also be a breathing technique. It could also be, you know, doing a five minute relaxation exercise on an app. It could be walking outside into the garden and sitting there for five minutes or to the park and so trying to get things happening on a regular basis.

It really reduces,

you know, helps to reduce the paras, the sympathetic arousal and helps to engage the parasympathetic calming, if that makes sense. So regular practice builds the skill.

Caroline: That's perfect. That's exactly what I was hoping to hear.

So now many parents feel guilty when they admit they're feeling exhausted and overwhelmed. Right? And you've just given us all these great tips. But what would you say directly to someone listening today who's thinking, I love my child, but I'm just so tired of being on alert all the time.

What would you say to this person right now?

Dr. Rotter: I would say that totally makes sense and that in fact two things can be true. You can love someone and care for someone very deeply like your child and at the same time experience fatigue related to food allergy management.

And I think keeping those things in mind, they don't cancel each other out,

they don't take away from each other. They both are true. And there will be times that are more difficult than others. And sometimes there'll be clear reasons, additional life stress, and sometimes there won't be any clear reasons.

But I think being able to recognize and acknowledge these feelings is key in being able to identify strategies and need for support.

And as I mentioned earlier, finding one's own ways of coping and incorporating these things into one's life regularly helps to keep the nervous system in a more balanced state.

Caroline: Wonderful. Thank you.

Before we say goodbye today, is there anything else you want our listeners to hear from you? I mean, this has been so information packed, but I want to make sure we give you a chance in case there's something else.

Dr. Rotter: The one thing I do want to say is I just want to reiterate that should someone find that strategies are not effective or sufficient or even with or without strategies, that they're experiencing anxiety, depression, or are unable to participate in their typical life activities, whether it be an adult, a caregiver of a child,

or a child that seeking mental health services is advised,

and for food, allergy specific mental health professionals. Asking your allergist or your child's allergist about possible providers and other resources can be accessed through one's primary care physician or pediatrician or through the Psychology Today

Caroline: website Nancy, thank you so much. Thank you ten times over for your time. You are so busy and we appreciate it so much that you always make time for us at FAACT and we appreciate you sharing your knowledge and your expertise but your passion which comes through and it's just so heartwarming.

And thank you for being here with us today.

Dr. Rotter: Thank you Caroline. It's a pleasure to be here. I love collaborating with you and with all of the FAACT team members and you're right, I am passionate about this. So I'm glad to come.

Comes through,

it does.

Caroline: So thank you.

Caroline: Once again I would like to say thank you to DBV Technologies for being a very kind and generous sponsor of FAACT's Roundtable Podcast.

Please note that today's guest was not sponsored by DBV Technologies or compensated in any way by the sponsor to participate in this specific podcast.

Thank you for listening to FAACT's Roundtable Podcast. Stay tuned for future episodes coming soon.

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Have a great day and always be kind to one another.