Ep. 241: Tools for Managing Stressful Food Allergy Moments

There are times when we must face hard and often stressful health-related food allergy situations, such as oral food challenges, immunotherapy, using epinephrine, and at-home self-administration of treatments. Although the outcomes may be excellent, we need extra tools to tackle these situations. We are privileged to learn more from Lisa Lombard, PhD, a licensed clinical psychologist and former Research Assistant Professor at the Center for Food Allergy and Asthma Research, Northwestern University's Feinberg School of Medicine. Her guidance will be instrumental in discussing and exploring strategies for handling these special food allergy moments!

Resources to keep you in the know:

• Lisa Lombard, PhD Website 

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Transcript

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 FAACT's Vice President of Community Relations.

Before we start today's podcast, we would like to take a moment to thank Genentech for being a kind sponsor of FACT's roundtable podcast.

Also, please note that today's guest was not paid by or sponsored by Genentech to participate in this specific podcast.

There are times when we must face hard and often stressful health related food allergy situations such as oral food challenges, immunotherapy using epinephrine and at home self administration of treatments.

And although the outcomes may be excellent,

sometimes we need extra tools to tackle these situations.

We are privileged to have Lisa Lombard, PhD, who is a licensed clinical psychologist and former research assistant professor at the center for Food Allergy and Asthma Research at Northwest University's Feinberg School of Medicine.

Lisa is going to share her expertise with us and her guidance will be instrumental as we discuss and explore strategies for handling these special food allergy moments.

Welcome Lisa to FAACT's Roundtable Podcast. We're absolutely thrilled and delighted and excited you're here and I am personally excited because I had the opportunity to work with you previously and I know just how outstanding your work is and your passion on this topic.

So welcome.

Lisa: Well, thank you very, very much for the invitation. I was thrilled and delighted to receive it and excited that we are going to have this conversation and I think the enthusiasm that both of us bring to the field and to helping others, I hope we convey it because I've always admired what you've done as well.

Thank you.

Caroline: Well, thank you.

I know you really well, but our listeners may not,

so let's help them get to know you and your expert.

So can you share your background and what drew you into our food allergy world and actually all your work that you do.

Lisa: Thank you. Sure. So I am a clinical psychologist and I studied and got my doctorate degree in psychology at the University of Chicago. I'm Chicago based but do work across the country because of psypact authorization.

So I do a lot of telehealth as well.

But in my role as a psychologist, I've always worked quite a bit with people who are managing anxiety and stress and pain.

And I have a specialization in working with children and families. And a good,

I don't know,

10, 12 years ago started to become apparent to me that a lot of the anxious children who I was seeing,

after a few sessions there would be some other information that might be, oh, we're managing a chronic health condition or oh, in particular we have food allergies in our family.

And so it just kind of became a thought for me and I started meeting more and more experts in the field,

allergists and families who were really devoted to understanding this topic.

And I started thinking about it and getting connected in particular to CFAR and other and allergists around the country to listen and talk about how food avoidance is really introducing anxiety into a person's life.

So in some, so many ways,

managing food allergies is about managing anxiety.

And it seemed really apparent to me, but it wasn't so apparent to other people initially.

Caroline: And we're glad you realize this and you're helping us with this. That's important.

And for listeners, CFAR is the Center for Food Allergy and Asthma Research at Northwestern University.

Lisa: Right. And so I was a research assistant professor there for approximately three years and contributed on the multidisciplinary team looking at the psychosocial implications of food allergies.

Caroline: So listeners, you can see we have the expert in the house.

So let's dive right into our topic at hand.

We know that there are moments that can be really difficult to manage food allergies during our lifespan, but they're, they're necessary moments and they're ones such as oral food challenges, using epinephrine, participating in immunotherapy, and even managing at home self administration of treatments.

So this is a lot.

So Lisa, how can families address the psychological burden of these moments?

Lisa: Absolutely. What an important question. Because developmentally we just know that there are some points along the family's trajectory that are going to be more difficult than others, that more stressful than others.

And then those that you've mentioned are really related to some healthcare treatment management concerns.

And I think first is to kind of give yourself some grace. They are going to be harder points,

but using what we know,

what our evidence based stress management skills and practices,

understanding how stress is really when the challenges around us exceed our own resources, either internal or external resources, if we know that we can do a lot more preventative work so that everyone can handle something like going in for an oral food challenge and understand what are going to be the especially difficult parts for that child or that family at that age.

You know, it does need obviously to be tailored to the individual.

I think prevention is really important in terms of if stress can make something more difficult, then managing stress can help.

And usually we don't say, just take a deep breath. We know that that's really not stress management and it's often too late.

So doing things on a regular basis to practice, to prepare,

to kind of build that mental muscle of stress management in advance helps when these difficult things unfortunately do come along, when perhaps you have to use your epinephrine or you have.

Did you have some other form of treatment or you're going in for a challenge, which can provide incredibly important information,

but is not always easy.

Caroline: Well, I know a lot of patients and children and caregivers get very stressed out over the oral food challenge. You just mentioned that even in my own home, my two adult children are pushing off an oral food challenge.

So if we were just to look at that.

Lisa: Yeah.

Caroline: What would be the steps to get to the challenge? But then afterwards, because you know, you just talked about stress management and it's not a one and done kind of thing, but it's something that has to be ongoing.

So if you can talk a little bit about how do we latch onto that and then how do we carry that through.

Lisa: Oh, I love the question. You're absolutely right. Because it's. It's a real world application that we need to talk about.

I think first of all, to depending, of course,

adult children are different than younger kids. But having conversations using language that's not even the word challenge can be. We can question, should that really be the proper vocabulary for this?

Because there's an implication perhaps that someone is going to fail or stumble on a challenge, and it's an experience.

So language, I think, is really important to talk about past successes and bridge to the current situation. You know, even though you were worried or anxious about xyz, about taking that test, or calling someone up and asking if they could come over to play, or worried about traveling on an airplane,

you did it. And the same kind of preparation and feelings can help you with an oral food challenge. So we bridge from one success to another.

I think the oral food challenge is a great opportunity to insert language that really talks about there's going to be. It's almost like a crescendo so even though it can be challenging, there's a point where you can say, okay, the worst is over.

Right? You've done this now.

You've waited that period of time and look at how the staff around you or the caregivers,

everyone has everything that we need to take really good care of you. So you emphasize the positive,

not that, you know, if you have some sort of reaction, we have your EpiPen right here and, you know, it will only be this many seconds. So you're trying to flip the narrative really to.

It's an experience where caregivers and experts are there and you're gonna get some really good information and the worst is over. At a certain point, you can. You can time it and.

And then, of course, celebrate that someone has done this.

I think that's really important. Excuse me. Important to celebrate that someone has done it. With younger kids, you might really need both verbal praise and probably, you know, some sort of like, we're going to go out and get that lunch now, or, you know, you're going to get that toy with a little younger child.

It's not bribery. It's the way that you can make some. Turn something a little bit more into a positive.

I think the other story, both for oral food challenges and for times when there's an allergic reaction,

is the storyline or narrative that the family creates about it afterwards.

So I don't know if you've had this experience, but there are some families that will talk about all of the really hard parts. You know, we had to wait for the medical person to get there or the.

We were sitting in the hallway at the hospital and we saw xyz, we. Or, you know, your teachers didn't know what to do. And I was so worried and I couldn't reach Daddy, like all of the hard things, but that creates a negative,

scary story so that the whole episode has a higher emotional valence. That's really quite difficult and negative.

I encourage people to look for some of the small moments, even remember when it was so funny that I couldn't find my keys or,

you know, you left the house and. And you were wearing one red shoe and one blue shoe, and create those moments,

find them. Yeah, it was difficult and there was an element of rising panic, but there was. You all got through it. If you're there to retell the story, hopefully in a healthy manner, you've all gotten through it.

So we know that when you recreate the story and have it have more of a positive emotional tone,

even your. Your experience of future pain Changes. You don't feel the pain quite so much because you're helping your nervous system reset and not be as vigilant and on the lookout for next episodes of scary moments.

Caroline: This is priceless. This is amazing. My head is just whirling. Looking back at what old food challenges.

And you're right. Instead of focusing on those heavy stress moments and things like that, but bringing in those kind of funny moments.

And actually, as you were saying that, I thought of one of my son when they were doing his dairy challenge and they were doing it with pizza,

and they took a slice of pizza and rubbed it on the inside of his cheek very first. And afterwards, my son's face was hysterical and he's like, mom, I feel violated.

Lisa: And we just couldn't see.

Caroline: Stop laughing.

But I see what you're saying now is to remind him of that as we go forward and talk about those things and how he got through it. And he discovered he was no longer allergic to dairy,

which was giant and so impactful. So I see what you're saying, because, boy, naturally, I would just go to. I was so stressful. It was so difficult.

Lisa: Right, right. And every time you can pivot away from that, you're kind of re. Rewiring, resetting things. You're encouraging some what we call neuroplasticity so that you can look at things with a different perspective or not be so sensitive to the next really difficult time.

I think you're absolutely right. That's a great example for him.

Caroline: For you, it was a funny story. Very funny.

Lisa: Well, thank you.

Caroline: This is really amazing information.

So now if someone's listening today and they have food allergies or they're caring for someone with food allergies and they want to take action, like they're. They're listening and they're hearing like, hey, there are going to be these big tough moments and sometimes continual.

Right. If you're in treatment,

what would be the next steps for them? Like, how can they now take action?

Lisa: Well, again, it's really important. It's going to be a little bit different for different families with different children, you know, in different developmental phases. But I think the idea of taking action is super because what it reflects is a sense of self efficacy, which we know is very important to caregivers and parents and children.

You want to do as well as possible. Right. Kids want to be successful. People don't wake up in the morning and say, today I want to be unsuccessful at this.

You want to have a good day.

And so taking action, even that Question. And the search for what to do next is the start of the journey that you are taking care of your children and your family and yourself.

I think getting good, solid information,

you know, from really vetted resources like your organization and others, is a huge place to start,

really important.

But I also then encourage people to break it down into tiny baby steps.

Even on an image of a ladder,

there's the lowest rung on that ladder, and that's where you start. What is the simplest, easiest step to take?

Is it, you know, getting information,

Making a telephone call, connecting to others in a group, Talking to your child again and again in simple, appropriate language about what to use, how to tell a friend that they have a certain food allergy.

Just to practice your role play and then work your way up that ladder. One, what's the next thing?

If you're concerned about going to a restaurant, you wouldn't say, you know, just sit down at the restaurant. You break it up into smaller steps. Calling or looking online at the menu, knowing what time might be less crowded time at the restaurant so that you could have an opportunity to talk more completely and thoroughly with the wait staff or with the manager or with the chef.

Having something written as well as something that you can say verbally to someone so that you can be as clear as possible and practice these different steps up your ladder.

And each ladder could look a little different. It might be about going to your cousin's house and having to tell your aunt what you can or can't eat, or pulling out the snacks on the right shelf in your own kitchen so that you do a good job of bringing it to the table.

All sorts of things to practice and to know that these small things layer into success and a sense of self advocacy.

Caroline: I love that. Layering yourself into success for self advocacy. That should be on a T shirt. I love that.

That is such a great statement.

And so listeners, Lisa's website has lots of information and all sorts of resources. But on that website,

Lisa,

you mentioned the word spot imbalance. Can you talk about that? I thought that was so fascinating.

Lisa: Yes, thank you for asking and checking that out. And I encourage people.

It's a little phrase. So we talk a lot about balance in the food allergy and anxiety management worlds. And it's sort of the Goldilocks principle, right? Not too much and not too little of something.

And certainly avoidance continues to be part of a treatment plan. Right? To be aware and to avoid. Even when people are in immunotherapy or are able to take biologics to Help.

There's an element of avoidance, but there's a sweet spot for that. There's not too much and not too little of the avoidance.

And so I started to think about enlarging upon that concept of balance,

which many of us recognize is important.

And the spot. There's a couple things. I think you're gonna like this because I tried to be clever.

Spot can be broken down into stress points over time. S, P O T.

And anybody who's thinking about a balance, either a balance beam, you know, or something where there's a scale,

there's that sweet spot, there's a fulcrum, and you are trying to reach that spot where it doesn't lean in one direction or in the other. It's like a teeter totter, a seesaw that can be level.

And also spots. When people are dancing or gymnasts, they pick a spot on the wall and they remain focused on it while they twirl around. So I felt it had a lot of layers, again, of meaning and could be helpful because we can talk about balance, but it can be hard.

And different days need different types of spots to help us find that balance.

Caroline: That is so clever and so fun. Oh, gosh. Thank you for sharing that. I love that. We're just learning so,

so much today and, and which is kind of a bummer because we're at the end of our time together. I can't believe it, but we've just learned fun.

I know this has been absolutely great. So we've been learning so much.

So before we wrap up today, is there anything else that you would like our listeners to hear from you?

Lisa: Oh, thank you. You know, I realized as you were saying that just now, so the. A key phrase and a concept in it that kind of goes along with all of this and has been really underneath a lot of my work for many, many years is about self regulation and co regulation,

you know, so we're talking about how to manage one's fears or anxiety. And that's a lot about self regulating. It's not being so overwhelmed by some of those experiences, by the thoughts that are really the worries, the what ifs and the feelings of, of nervousness and dread.

But then there's CO regulation, which is within the often parent, child,

couple, dyad or caregiver or even healthcare provider.

Kids turn to the adult and check, right? And take a look and measure how is the adult feeling and what is their level of stress. And that sends a message to the child.

So again, what should you do? It's a lot about being able to co regulate, to regulate yourself. If you're the parent, the adult,

the caregiver, the healthcare provider, take a couple of deep breaths before you go into something.

Remind yourself that you're going to be fully present right now and then you'll be a better source of help and support for the child going through some of these experiences.

So co regulation is also really important.

Caroline: That is a term I don't think I've heard before. And so this is fascinating.

And you know, this has just been again, a great talk, a great discussion, lots of good information and listeners. I will have how to get hold of Lisa and all that information in the show notes.

So take a peek. But Lisa, thank you so much for your time today. This has been utterly fantastic.

Lisa: You are so welcome. Thank you for this invitation and your great questions and interest and curiosity and I appreciate it. Caroline, Wonderful to be here today.

Caroline: You are very welcome. Thank you.

Before we say goodbye today, I just want to take one more moment to say thank you to Genentech for their kind sponsorship of FAACT's roundtable podcast.

Also, I want to note that today's guest was not paid by or sponsored by Genentech to participate in this specific podcast.

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