Medical prescription to strictly avoid or anxiety?

[twinturbo]

Rarely does something truly anger me but this article does the trick. Its shoddiness in vague recommendations and conclusions based off second hand information while making such profound statments such as "all the experts whose information I'm using agree with me..." Really?

http://www.hindawi.com/journals/ja/2012/316296

With all due respect to learned individuals who address anxiety disorders I am continuously dismayed that they blind themselves to the chronic status of IgE-mediated environmentally triggered anaphylaxis. They continually ignore the LONE PRESCRIPTIVE MEDICINE is strict avoidance. A current, real concern is fear, a vague dread about what may happen is anxiety. The nature of the trigger and chronic state that may be triggered is current. Avoidance is current. There is NO mediating steps other than active vigilance.

Give me some sort of other prescriptive action than total avoidance of all triggers for a chronic condition, then label it a harmful behavior otherwise it is practising medical advice.

[SilverLining]

I'm not sure why this article makes you so angry.  It's not intended to help deal with the actual allergies, but with the anxiety associated with them.

I completely agree that the least restrictions that are safe is best, and sometimes (for some people) anxiety causes more restrictions then the actual allergy requires.  for this particular article, it would be inappropriate to say how much restriction is required, because that is different from one individual to another.

Since I am not the parent of an fa child, I will use insect allergy as an example.....

FOR HIM, it would have been unreasonable to not allow him to go on school field trips.  Even a three day trip to an outdoor camping was possible to make reasonably safe.  that might not be true for another child with insect allergies, but it was doable for him.  I had a school principal accuse me of putting him at unnecessary risk by allowing him on the trip.  (she was overly anxious about it and tried to guilt me into keeping him home.). For a different child, or at a different camp, it might not have been a safe trip.

My son is extremely afraid of insects.  He has jumped in front of a car to avoid a butterfly.  that is NOT a healthy fear, it's over-anxious and puts him at more risk then an insect he is not allergic to.

a comparison could be made to fa's......a child (and parent) avoiding healthy foods that the child is not allergic to - out of fear - and not going places that are not a risk, is an unhealthy amount of anxiety.

But, to state exactly where that line is between safe/unsafe would be different for each person.

[CMdeux]

SL, I agree (as you know)...

but I think that this is the missing bit in between allergy/immunology and the psychology of management.

The line between the two things is so variable as to seem (to the uninitiated, at least) like a mirage, and nobody REALLY knows when it's been crossed for an individual except for that individual/his or her immediate family.  And sometimes not even then.

Any one-size-fits-most prescription here is foolish and arrogant/presumptuous.  I think that is what makes TT (and me, too, if I'm honest) so ANGRY at mental health professionals and professionals who really ought to know better than to make such statements (Christakis, anyone?) when they spout an opinion which isn't:  a) based on evidence, or b) nuanced enough to allow for individual variance/need.

I mean, consider the statement "There is no reason for an allergic person to avoid all flying insects."  Well, obviously this is true, at least so far as the surface statement goes.  On the other hand, it neglects two important features-- allergic to what, exactly?  and, just as critically, with what sort of reaction history??  To be afraid of a not-yet-identified insect... might be reasonable... but to be afraid of an insect that one HAS identified (and does not pose a true threat-- such as a moth to a honeybee-allergic person, for example) is not reasonable or rational.  To treat all flying insects with a certain amount of caution until that evaluation can take place, though-- that's probably somewhat reasonable.   KWIM?

We treat food the same way-- with suspicion until we can evaluate risk based on information.

For some FA children, avoiding a baseball game is unecessarily restrictive.  For some FA adults, even, it's an unthinkable environment-- basically there is virtually no 'benefit' that would outweigh the risks involved.

That's what it boils down to, ultimately.  The risk is real.  This is not a phobia, and for mental health clinicians and researchers to TREAT it that way is insulting and misses the real issues here.  For anyone to live healthily and reasonably safely with a life-threatening allergy requires accurate, continuous and razor-sharp risk-perception skills.  When those go awry or are impaired for any reason, that is when bad things happen.  Denial is no better than over-reaction, however.

[SilverLining]

I don't think the author is saying it's phobic or unreasonable to have some fear and anxiety.  it becomes a problem when an indivual or parent is restricting beyond what is required.

Given the life-threatening nature of anaphylaxis, this anxiety is understandable especially within the first few months after diagnosis or after a reaction. Some anxiety in the face of anaphylaxis may even be adaptive, as anxious children are less likely to take risks with respect to their anaphylactic conditions than children who are not anxious [2].

After I was in the hospital for an anaphylactic reaction, I was afraid to go anywhere.   Was scared to walk to school to pick up my kids.  That is not normal anxiety for a person with an allergy.  (In my case, testing negative to my allergens contributed to this anxiety lasting a lot longer.). That level of anxiety might be normal after anaphylaxis....but it lasted two years for me.

Because of my reaction over the weekend, I'm feeling much more anxious about eating.  For right now, I think that's normal, but if it goes on too long, it's crossing a line and limiting me.  I can already feel the fear of Christmas celebrations, which is a normal fear for some people, but is not reasonable for me.  (you understand the difference?  I am NOT saying it's an unreasonable fear for others, but it is an unreasonable one for ME because my celebrating is in homes of people who have always gotten "it".)

Who is the target audience for this article?

[CMdeux]

Clinicians and other researchers, presumably.


Oh-- and I totally agree with your last post, SL.  I also think that part of that extended caution has some basis in medical necessity, though-- because a recent reaction lowers the threshold for an additional one for a lot of people. 

[SilverLining]

Clinicians and other researchers, presumably.

That's what I was thinking too.

Now, if as a parent, you felt your child was over-anxious about his/her allergies and the anxiety was having a direct negative affect on his/her quality of life and/or health.....who do you go to for help?  An allergist who does not understand anxiety (beyond the normal) or a psychologist/psychiatrist who has only a passing understanding of allergies?  (haven't we previously discussed on this forum that nobody seems to really understand both?)

when I read the article, I saw it as a first step in this direction.  Somebody has realized there is a need for this.  To me, this article does not look like the final step.

[maeve]

SL,
I mentioned DD's anxiety to her allergists staff and they had a list of therapists/psychologists/psychiatrists that they could have referred us to.  At the time of our appointment, DD's anxiety had abated because I had worked with her to explain what was truly a risk and what was not (after entering public school she'd started to freak out when seeing sealed jars of PB on store shelves).

[SilverLining]

I'm glad your allergist has a list of doctors to send patients to.      I'm not sure all doctors do.

[CMdeux]

Ours does not.

But this isn't for lack of effort-- it's because there is truly a lack of individual mental health professionals that understand that some conditions come with rational levels of anxiety.  Unless the anxiety is truly crippling and irrational, I think that his assessment is that you're better of DIYing things and muddling along-- rather than seeing someone who is going to assume that you're truly CRAZY for perceiving risks that anyone who lives with food anaphylaxis knows are, um... real, if eccentric-seeming.

Example:  I pull my jacket sleeves down over my hands to open doors in public.  Always.  I also don't use pens in public-- I carry my own in my purse-- and wash my hands when I come into the house.  Does those seemingly OCD behaviors have a purpose in managing real risk?  You'd better believe they do.  On the other hand, plenty of counselors/therapists and even physicians have interpreted this with amusement... and would no doubt have the sense that I might be a little over the top since it BOTHERS ME to 'break' one of those rules.

On the other hand, my response to that sense of disquiet isn't to go back and 'repeat' the behavior, but to take mitigating measures (handwashing, mostly) ASAP.  I think that is what differentiates it. 

[maeve]

We're lucky DD sees Dr. Wood and that he's at Johns Hopkins.  Having access to a teaching hospital truly makes a difference.  I doubt the suburban allergist we saw when DD was first diagnosed with egg allergy at 9 months would have had such a list.  I got the sense from the nurse practitioner's reply that it was not uncommon for them to see patients who ended with disordered eating because of their food allergies and the anxiety related to them.

[maeve]

CMDeux,
After watching "Contagion" your handwashing, etc. approach seems perfectly reasonable.