Anxiety or Anaphylaxis?

How to distinguish anxiety from an allergic reaction in food challenges.

During my 15 years living with food allergies, I have endured two physician supervised food challenges in my doctor’s office. What I have learned through the nurses and doctors’ responses to me is that I must be keenly aware of my own body and manage anxiety, so that the symptoms are not blurred, and I am taken seriously.

When we get anxious, we tend to feel a rapid heart rate, facial flushing and tingling, or panicky sensations can take over. Sometimes people experiencing anxiety can even break out in hives. As you can imagine, allergic reactions to food can trigger some of the same physiological reactions. How do you differentiate your symptoms, and how do you inform the staff of what you are truly experiencing? 

My most recent food challenge was last year. I started with the tiniest bit of peanut butter (1/4 of a teaspoon). I have previously experienced a couple anaphylactic reactions (that we ignored a little too long before administering the EpiPen). Those experiences familiarized me with how my body has responded to allergens. I must be honest, while I have been anxious in the past about food allergens and reactions, during my teen years I have been a little more relaxed about it. I did not feel extremely anxious about this food challenge.

I did some tips and tricks (thanks to having a mother who is a cognitive-behavioral psychologist) to calm me down, and they worked! I reminded myself that I’m in a safe supervised office with nurses, doctors, and my mother’s full attention. It helped to focus on the positive outcomes rather than the negative ones. Maybe I can finally delve into a bag of Reese’s peanut butter cups (my sister’s favorite candy that she swears by). Perhaps if I can tolerate peanuts I don’t need to be as worried in social situations and college down the road. I prepared for the worst-case scenarios with comfort. The worst that happens is I am administered an EpiPen from a nurse or doctor, which I have previously experienced, and it is not painful or traumatic and instantly relieves symptoms. I also used music and TV shows for distraction. 

Shortly after ingesting my first peanut exposure, I felt my throat burn like fire. When the nurse came in to check on me, I reported this symptom. She said, “nuts can feel funny if you have never tasted it. Probably just fear or anxiety.” We accepted that as a possibility, and my mother and I kept on with our distractions. A few minutes later, I felt fire in my ears that seemed to transcend into my stomach area. I reported this to my nurse (as my mom and I remained calm knowing we were safe). Again, she was a little dismissive saying that food challenges often provoke a lot of anxiety in kids and teens, and it most likely was my fear of it. I physically looked okay, and my vital signs were all good. I assured my mom privately that I was not the least bit anxious (and neither was she) and that I truly believed this was the beginning of an allergic reaction.

A couple minutes later I was extremely nauseous, I felt like I needed to vomit, and my face became irregularly pale. The nurse was alerted and was watching but still felt that at this point I had worked myself up. I became insistent that I felt horrible, and this was not anxiety. My mother also spoke up saying that I was incredibly reliable with my reporting of medical symptoms, and this did not seem like anxiety. The physician came in to check on me and clearly noted that I had multiple physiological reactions and that we waited too long for an EpiPen. He administered it, and within a minute my entire symptoms resolved. I felt like a new person. 

I share this story because I feel that it’s important to, first, attempt to manage the anxiety symptoms as best as possible when dealing with possible allergen exposure/reaction so that it is easier to decipher anxiety from anaphylaxis. Secondly, it is important to advocate for your body and symptoms so that people respond to you and action is taken as quickly as possible. Knowing your body and feeling comfortable enough to speak out can save your own or someone else’s life when dealing with severe food allergies.