In Part Two of Our Academic Blog Series for Food Allergy Awareness week Dr Béré Mahoney, from the School of Psychology, leads a team of University of Worcester researchers who are exploring what is it like psychologically for adults living with the severest of allergic reactions or anaphylaxis. Here, Dr Mahoney along with team members Professor Eleanor Bradley, Director of Research for Health and Science, and Dr Steve O’Hickey, Honorary Professor and Consultant Physician at Worcestershire Acute Hospital NHS Trust, discuss what food allergy is and what is it like living with one.
To discover more about what food allergy is, how intolerances and allergies differ and how psychological factors can influence this see Part One of this Series. In Part Two we will be looking at how food allergy differs from other allergies, how we diagnose food allergy and our Psychological Research into food allergies
Is having a food allergy different to having an allergy to bee and wasp venom, a prescription drug or even anaesthetics?
All of these reactions can be serious and affect individuals with an allergy, but food allergy in particular has a big impact on the quality of a person’s life, something Professor O’Hickey has found among patients in his clinic. He has found that most patients would agree that allergen drugs or insect venom can usually be avoided by the individual. In contrast food - particularly when prepared by someone else - can very often be a cause for anxiety among the food allergic because they have less control over their exposure and avoidance to this.
In his clinic Professor O'Hickey sees many patients with newly diagnosed food allergy, and, for some, this can be serious requiring further sophisticated blood tests to cast more light on the trigger allergens for that person.
Finding this out can be vital - avoidance of the allergen is the first step in effective management of the condition so identifying this can help us develop a self – care plan. Our research with adults, including those with the severest form of food allergy - anaphylaxis which is a serious and life-threatening reaction - confirmed this: having a sense of certainty and control about their anaphylaxis by knowing their trigger food or foods and therefore being able to avoid the trigger, is particularly important psychologically to this group
Yet, this can be more challenging than many people realise. Modern food preparation and manufacturing are complex. For example, it is relatively well known that pesto contains pine nuts and should be avoided if allergic to them, but again some versions of this common sauce also include cashew nuts and trigger unexpected reactions in individuals sensitive to these specific nuts. Many food items are subject to cross-contamination (a process by which foods are unintentionally mixed) or manufacturing methods may make identifying possible allergens difficult.
How do people get diagnosed with a severe food allergy?
In many allergy clinics the patient’s allergy story is key – it is reviewed carefully and Professor O’Hickey says that taking a detailed history is often the most important part of the diagnostic process. Allergy tests are usually performed and finally, when we are sure of what we are dealing with, we will often prescribe adrenaline auto-injectors for occasions when despite informed avoidance, exposure occurs.
Sometimes the allergy process can be even more complicated because of co - factors or factors in combination with one another.
(A co-factor can be a contributory cause to the anaphylactic reaction)
For example, exercise combined with the eating allergen whether this is a food or a medication such as some pain killers, can for some individuals create the circumstances where a reaction will occur.
What is our research on anaphylaxis at the University of Worcester about?
Our research focuses on individuals diagnosed with anaphylaxis for the first time in adulthood. Certainly, high profile cases of fatal allergic reactions to substances found in common foods are a timely reminder of the challenges faced by the growing numbers of individuals living with this most severe and potentially life - threatening form of allergic reaction. We know that, whatever the age of the individual and their specific trigger allergen, living with anaphylaxis is a complex psychological and social experience. However, across our work we have found that individuals with adult onset severe food allergy, and living with the risk of anaphylaxis face some unique challenges :
- they can find it difficult accepting the diagnosis and living with a condition that they feel is associated with children
- trying to avoid their trigger food allergen can have a profound and problematic impact on the quality of their life and that of their family, especially around mealtimes and social gatherings
- they can find it difficult to develop new ways of managing their health after years of engaging in other health behaviours and habits
- it can be difficult for family members and health care professionals to know when and how to support the severely food allergic adult because they have more control and responsibility for managing their health than a child or younger person with a severe food allergy
Training health care professionals who work with individuals with adult onset severe food allergy in psychological skills is one important part of our research. We have found that among the nurses, medical doctors and pharmacists we have worked with, many are often unaware of the unique psychological experiences of living with a severe food allergy among these adults . Training health care workers in techniques they can use to explore these psychological issues with patients seems to benefit these professionals and potentially the adults with severe food allergy that they support.
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 Walklet, E., Taylor, C., Bradley, E., Mahoney, B., Scurlock-Evans, L., & O’Hickey, S. (2018). ‘Because it kind of falls in between, doesn’t it? Like an acute thing and a chronic’: The psychological experience of anaphylaxis in adulthood. Journal of Health Psychology, 23(12), 1579–1589. http://doi.org/10.1177/1359105316664130
 Walklet, Elaine, Mahoney, Berenice, Bradley, Eleanor and O'Hickey, Stephen (2019) Application of Health Psychology: Development of a Practitioner Training Intervention in Anaphylaxis. Journal of Continuing Education in the Health Professions. ISSN Print: 0894-1912, Online: 1554-558X (In Press) http://eprints.worc.ac.uk/7840/
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