October 14, 2025 • 33 mins
Food allergies don’t just bring the fear of anaphylaxis. They also bring unique social challenges that are often overlooked. In this episode, I sit down with psychologist clinician and researcher Dr. Melissa Engel, whose recently published paper introduces a new model for understanding social anxiety related to food allergies.
We discuss why this distinction matters, especially for adolescents navigating peer relationships, independence, and identity alongside food allergies. Dr. Engel shares her hopes that this framework will inspire better screening, more targeted treatments, and a broader acknowledgment of the emotional toll that living with food allergies can take.
If you’ve ever felt that the mental health aspects of food allergies aren’t fully recognized, this conversation will validate your experience and point toward a future where research and care finally catch up to what families and patients already know.
Read Dr. Engel's paper here:
https://pmc.ncbi.nlm.nih.gov/articles/PMC12400901/
Center for Food Allergy And Asthma Research (CFAAR):
https://www.feinberg.northwestern.edu/sites/cfaar/index.html
Episode 32 with Dr. Katherine Dahlsgaard mentioned in our discussion:
https://dontfeedthefear.buzzsprout.com/2371319/episodes/17506930-building-bravery-tackling-allergy-anxiety-with-dr-katherine-dahlsgaard
Special thanks to Kyle Dine for permission to use his song The Doghouse for the podcast theme!
www.kyledine.com
Find Dr. Whitehouse:
-thefoodallergypsychologist.com
-Instagram: @thefoodallergypsychologist
-Facebook: Dr. Amanda Whitehouse, Food Allergy Anxiety Psychologist
-welcome@dramandawhitehouse.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker (00:01):
Welcome to the Don't Feed the Fear podcast, where we
dive into the complex world offood allergy anxiety.
I'm your host, Dr.
Amanda Whitehouse, food allergyanxiety psychologist and food
allergy mom.
Whether you're dealing withallergies yourself or supporting
someone who is, join us for anempathetic and informative
journey toward food allergy calmand confidence..
(00:22):
Welcome back today on Don't FeedThe Fear.
I'm joined by Dr.
Melissa Engel, a psychologistand researcher who recently
published a groundbreaking paperthat introduces a model for
social anxiety related to foodallergies.
While many of us living thisreality have always known that
social anxiety is a verydifferent experience from the
fear of exposure to ourallergens or anaphylaxis, the
(00:43):
scientific literature hasn'treally caught up until now.
So in our conversation, Dr.
Engel explains to us why thisdistinction really matters how
under researched the mentalhealth aspect of food allergies
is compared to other medicaldiagnoses and the hope that this
new framework will lead toscreening measures,
evidence-based treatments andtools that truly address the
(01:04):
challenges that families andindividuals are facing.
Amanda Whitehouse, PhD (01:07):
Dr.
Engel, i'm so excited to haveyou here to talk about your work
in the overlap of food allergyand allergic diseases and mental
health constructs, and your newpaper, which was just published
at the beginning of this month.
Thanks for joining us.
Melissa Engel, PhD (01:20):
Thank you so much for having me.
I'm excited to be here.
Amanda Whitehouse, PhD (01:23):
Can you tell people, what your,
professional focus is now, andhow you got into the world of
food allergy research?
Melissa Engel, PhD (01:29):
Yeah, absolutely.
So I am currently In my secondyear of a two year postdoctoral
fellowship in psychology atLurie Children's Hospital in
Chicago, which is the Children'sHospital of Northwestern, and
I'm in the center for FoodAllergy and asthma research at
Northwestern, which is alsoknown as cfar.
(01:52):
Um, and my work is like halfresearch and half clinical, so
my time is.
with patients with a variety ofmedical conditions.
And then the rest of my time isspent doing research at cfar.
And that is really on, um, themany psychosocial difficulties
that patients with foodallergies may face.
(02:15):
And I originally got into thiswork.
Based on my own experiencesgrowing up with food allergies,
I never intended to go into thisfield or to really do anything
with food allergiesprofessionally, but as I began
graduates.
Goal for clinical psychology andlearned more about pediatric
(02:39):
psychology and how psychologywas so integrated into so many
other medical specialties.
I noticed this huge gap, um,when it came to food allergy,
and so I decided to go back tothat route and what I knew
firsthand.
well.
Um, and so kind of combined likemy own experience working with
(03:02):
patient organizations throughlike volunteer type roles for
several years and just my ownexperiences growing up and then
my professional training, um,with many, many years of
graduate school in clinicalpsychology.
Amanda Whitehouse, PhD (03:18):
Some of the kids do the teen counselor
programs, with advocacyorganizations, did you start
that young and then get backinto it,
Melissa Engel, PhD (03:24):
Yeah, I was involved when I was a kid
actually.
One of the, I guess, highlightsof my very early career was when
I was in fifth grade and I did,The Kids Congress on Capitol
Hill, FARE was formerly FAAN andit was a fan kids Congress on
Capitol Hill.
And, um, Barack Obama was mystate senator, so I got to lobby
(03:48):
to him, um, about food allergylegislation.
So that was pretty cool.
And at that point I thoughtmaybe I would go into politics,
um, that never went anywhere.
Um, but I was in the teenadvisory group when I was in
Mills.
School and high school, um, andhelped out with some of the
programs at like the nationalconferences.
(04:10):
And then I, I pretty much likepaused in college because I was
busy with.
and education and everythingelse that comes with that.
And then once I entered graduateschool and had known I wanted to
do pediatric psychology again,had no interest in going back to
(04:31):
food allergy.
Um, fair actually reached out tome, um, to ask to help with
their teen engagement at thestart of the pandemic as, um,
you know, everything was.
Very different in early 2020.
Um, and that led to me gettingvery involved and having like
(04:52):
frequent zoom meetings withteens with food allergies and
then realizing, um, one that Iabsolutely love this, and two,
that there was so much need forwork in this space.
And just like looking at theexisting research and, and a
variety of other chronic medicalconditions compared to food
allergies, the um.
(05:13):
The mental health research andfood allergies and, um, clinical
care provided, it is prettysparse.
so then I'm like, okay, this iswhat I'm going to do for the
rest of my life, presumably.
Amanda Whitehouse, PhD (05:26):
Well, I'm so glad you did because you
know I asked that'cause I want.
People to understand that youreally know this from every
angle inside out.
You know, the clinical angle,the research angle, all
directions that are important toconsider combined into the
knowledge that you bring to thetable.
And I, I wanna talk about yourresearch, but I'd be curious
first, about what your clinicalwork looks like
Melissa Engel, PhD (05:46):
yeah, of course.
Um, so my clinical work is, um,a variety because, um, I'm in,
so I'm in my last year oftraining, um, as a postdoctoral
fellow, and I see patients witha variety of chronic and acute
medical conditions as well aspatients, um, without medical
(06:08):
conditions, but just, um,anxiety disorders, depression,
et cetera, like.
Children through adolescents,um, and sometimes young adults.
Um, and I see patients who arehospitalized inpatient, um, as
well as more patients in inoutpatient setting.
And I have some patients withfood allergies or asthma, um, as
(06:32):
well as patients with a varietyof other.
Chronic medical conditions like,um, type one diabetes, epilepsy,
um, gastrointestinal conditions.
It really varies.
Amanda Whitehouse, PhD (06:47):
What is the.
Difference.
Difference in being an effectivepsychologist to someone when
it's related to medicalconditions versus things that we
would think of as more purelyor, or you know, wholly mental
health based.
Melissa Engel, PhD (07:03):
That is a really good question, medical
conditions influence your,physiological symptoms.
So you often have that overlap.
And then there's a lot ofself-management behaviors that
are required to stay safe, um,or manage conditions
appropriately.
They.
Can be difficult.
Um, there's oftentimes adherencedifficulties, um, social
(07:27):
difficulties with speaking upand self-advocacy, especially
for kids and teenagers who, um,necessarily wanting to do that
because they just want to.
quote unquote be normal and fitin.
Um, and there also is just likethis extra layer that other
people don't experience.
(07:48):
Um, then when, when it comes toanxiety, which is what I see a
lot of the times, I think thatsomething, especially in in food
allergies that I hear is thatthe, like some level of fear is
so adaptive.
To stay safe and, um, with some,like other fear, like being
(08:10):
scared of the dark or scared of,um, an animal that you would be
unlikely to encounter or otherlike very improbable things, um,
like managing something likefood allergies or other medical
conditions does require a lot ofvigilance and preparedness and
(08:31):
speaking up and like.
That, that level of fear ishelpful to some extent.
Amanda Whitehouse, PhD (08:38):
Right, right.
Because the very things that youdo need to do that are
productive and that are helpfuland supportive and create safety
can become problematic if you dothem too much or too, too much
of an extreme or too often.
Melissa Engel, PhD (08:50):
Yes, I.
Amanda Whitehouse, PhD (08:51):
It's tough to shoot, but that's how
you feel safe.
So you would just wanna do itmore often.
Melissa Engel, PhD (08:55):
Yes.
And I also think that sometimesthis understandably gets missed
by medical providers, um,because if they see that
patients are being reallycareful, for example, um, that
often gets reinforced.
Amanda Whitehouse, P (09:11):
Absolutely encouraged medical providers and
parents, I think will tend toreally get involved if they
perceive that a child is notbeing cautious, but they'll
praise and elevate, oh, they'reso responsible.
They got, they're mature sincesuch a young age, which is true
and can be good, but, um, Ithink it gets nurtured and
encouraged sometimes more thanis helpful.
Melissa Engel, PhD (09:33):
Yes, I would agree.
Amanda Whitehouse, PhD (09:36):
So let's talk about your new paper.
Food Allergy Related, socialAnxiety, novel Conceptualization
of an Important but OverlookedConstruct.
And I love that you wrote thispaper you and I were talking
beforehand about how you saidyou've been thinking about this
so long, and I was shocked whenI read your paper like, of
course this is the case, butit's not something that had been
(09:56):
established, professionally inwriting.
So please tell us about thatprocess of taking that from an
what to you was an obvious ideaand writing it and sharing it
with the community.
Melissa Engel, PhD (10:06):
Yeah, when I, when we were talking before
it, it's almost like comicalthat this, like if you talk to
anyone, but especially youngpeople with food allergies, this
is such a salient and obviousissue, yet it has not been in
the literature.
Um, so I've been wanting towrite something like this.
(10:28):
For several years and just with,um, all of the demands of
training and other projectshadn't gotten around to it.
And once I did, I was sothrilled that all of the
wonderful co-authors weresupportive of this idea so that
we could come out with this,with this paper and continue
(10:48):
this research in, in the future.
But I think something thatreally struck me was.
When, so since 2020, I've beenleading Teen Talks for Fair,
which is, a monthly virtual peersupport program for youth with
food allergies between the agesof 11 and 22.
(11:09):
and we meet monthly.
Between 40 and the, our recordwas 93 teens each month, and
it's just basically a peersupport program where they talk
about the difficulties they facein daily life, as well as
exchange tips, and even discusslots of non-food allergy related
(11:31):
things.
Like one time they werediscussing, um.
Like ranking Oreo flavorsbecause everyone in a certain
breakout room could have Oreos.
They were safe for theirallergies.
And I'm like, what?
What discussion question are youon?
And that was the, what they werediscussing.
Amanda Whitehouse, PhD (11:45):
Oh, what a normal conversation for them
to get to have.
They might not otherwise.
Yeah.
Melissa Engel, PhD (11:49):
Yeah.
Um, so anyway, I lead thisprogram and we always start with
polls and I think it was thethird anniversary of this
program, like three years.
Um, and I, it was birthday partythemed, so I made a poll, um,
about what parts of like.
(12:09):
What aspect of attending abirthday party is like the most
difficult and with respect tofood allergies, and there were a
variety of options to choosefrom, but one of them was like
being scared of having areaction.
Um, one of them was like wantingthe cake, but then looking so
good and like not being able tohave it.
(12:30):
And one of them was.
Just like being asked questionsabout like, why you're not
eating the cake, or just likefearing being negatively
evaluated or perceived asdifferent or difficult or overly
cautious or things like that.
Um, for not eating the cake orpizza or whatever else that you
(12:51):
can't have because of your foodallergies.
And that third option was by farthe most chosen and that kind of
struck, stuck, uh.
Struck me as like evidence thatlike, yes, this is actually a
thing.
This is not just imagination.
And for these teens with foodallergies on this, you know,
this was like a veryself-selected group of 60 or so
(13:16):
people who chose to attend this.
But for them, it really was notthe fear of having an allergic
reaction, but the fear of justthis, like being negatively
socially evaluated by others atthe birthday party for.
Turning down the cake for noteating anything, for bringing
their own cake, et cetera.
Um, and it was that one timewhere I'm like, okay, I have to
(13:40):
do work in this area because itneeds attention so that we can
improve things.
Amanda Whitehouse, (13:47):
Absolutely.
And people listening might notunderstand.
Why does that matter?
Why is it important to make thatclarification?
Melissa Engel, PhD (13:55):
Yeah.
Um, so I right now, like in, inthe past.
Few decades, but especially likein the last decade, there has
been so much more of a focus onanxiety and food allergies and
also just like on mental healthin general and people without
food allergies and um,especially in youth.
(14:15):
And that is great.
Um, and I'm so glad.
and mental health in general isbeing addressed in food allergy
because like when I was growingup and attending these
conferences, there wasabsolutely no, no
acknowledgement of this.
So we've made so much progress.
Um, and at the same time, a lotof times when people are talking
(14:38):
about.
Anxiety in those with foodallergies.
They're really talking aboutthis fear of an allergic
reaction.
and that is very true and veryprevalent and very important.
And at the same time, addressingthat fear is very different than
addressing the socialimplications.
(15:01):
So if you find out that someoneis as anxious with respect to
their food allergies, it'sreally important that you figure
out like what that fear or whatthose fears actually are.
Because you would treat them in,in very different ways.
Like if someone was fearful ofbeing in close proximity to
their allergen, but it wasdeemed safe.
(15:24):
By their allergist to do so.
Then you could practice havingthem, you know, be at a birthday
party sitting next to someonethat's eating something they're
allergic to, versus if they fearthe negative social evaluation,
you can practice like speakingup for yourself.
You can practice intentionallyeating different things around
(15:46):
other people or, having kind oflike a.
Scripts that you say when atrestaurants, for example, even
like some patients that I'veworked with, we practice like
calling places or like orderingat certain places.
When the fear is actually thatthey're being perceived as
(16:08):
difficult or that people likewon't understand them or will
dismiss them as opposed to likefearing that they're actually
going to have an allergicreaction.
Amanda Whitehouse, PhD (16:18):
Right, and it's one of those examples
of what we should do, but oftenis not automatic really to
listen and understand someone.
Let them express their fear andarticulate what's bothering
them, rather than assuming thatwe know what's going on and we.
Assuming we know what kind ofhelp they need.
'cause as you described, it'ssuch a different kind of support
and a lot of people, I wouldassume, and in my clinical
(16:39):
experience, need both, but atdifferent times, you know, they
might have a combination, butthe thing that's bothering them
right now might not be the thingthat pops up next month that
they're nervous about.
Right.
It would be a combination.
Melissa Engel, PhD (16:49):
Yes.
Yes.
And it could be different basedon just like who they're with or
like the context or, um, how oldthey are or so many different
factors.
A, a big one that I think abouta lot and hear teens talk about
a lot is dating.
Um, and then that there, there'sa contrast of like.
(17:11):
that someone could have anallergic reaction from kissing
someone who has consumed theirallergen.
Um, so that would be like thefear of reaction versus other
people.
And what I actually hear a lotmore of is like.
Being rejected for being likeperceived as difficult or like,
(17:31):
you know, having to takeprecautions when kissing or um,
only going to certainrestaurants that have good
allergy precautions and thingslike that.
Um, and actually with the teensI work with, we often joke
about, um, like the Karen memewhere Karen, like a few years
ago, was that, um.
(17:53):
that wanted to talk to themanager and is like demanding.
And um, we sometimes joke thatuh, sometimes people with food
allergies, um, are seen ascoming across that way, which is
unfortunate.
Amanda Whitehouse, PhD (18:07):
Right, because they're seen that way
and they feel that way, and you.
At it's a totally differentthing because a Karen is someone
who's unnecessarily making astink, and that's not anyone
with a food allergy, what I'veever seen them do.
Right.
Melissa Engel, PhD (18:18):
yes.
Amanda Whitehouse, PhD (18:19):
For the most part, people are afraid of,
again, the social perception.
How will this come across to thepeople?
Particularly we all remember howdating is so nerve wracking.
without food allergies in thepicture, it's all about how does
this person perceive me?
So I think that's such a goodexample of how both of those
aspects of the anxiety wouldcome into play.
But it's, I think, easier tocomprehend why this specific
(18:44):
social anxiety piece is soimportant, it's an important
thing at all ages, butespecially to teens as social
perceptions.
Melissa Engel, PhD (18:51):
Yeah, and like, just like thinking about
like the demands of effectivefood allergy management, like
carrying epinephrine, Askingquestions like speaking up, like
it, they're, they kind ofconflict with the, the, like
adolescent development andwanting to just fit in, wanting
(19:12):
to take risks, all those things.
So there's like this tension.
Amanda Whitehouse, PhD (19:17):
Yeah, there is, and it just highlights
how important it is to know whatyou're working with and know
whether you're a clinician orwhether you're a parent.
What's this?
Kid, or what am I as an adult,what's the actual problem or the
fear here in this situation sothat I can address it
accordingly?
And I know, for you, this isjust the beginning of future
work that you see because youwanna establish this so that you
(19:38):
can do lots of things with itmoving forward.
So tell us what you see in thefuture based on what you've
established here in this paper.
Melissa Engel, PhD (19:45):
Yes, I am.
I'm very excited to have thisout so that it kind of like
unlocks many new directions thatI can take this.
So I'd love to develop a measureand.
Starting to do that, um, thatproviders could use to screen
for food allergy related socialanxiety because the existing,
(20:07):
um, questionnaires concerninglike anxiety and food allergy
specifically are, are reallyabout this fear of allergic
reaction.
And so this isn't really beingcaptured, so we don't really
know.
What this looks like in, um,individual patients.
And also we don't know what itlooks like at scale, like how
(20:29):
big of an an issue is this.
And I also just wanna emphasizethat a certain level of social
anxiety is like normative.
And I mean like of course it'sgood to care to an extent what
people.
Think about you, and it's greatthat teens want to be normal,
(20:49):
for example.
but when it prevents'em fromengaging in like appropriate
allergen management or when thislike fear of being negatively
evaluated, prevents them fromengaging in social things,
that's when, um, it would.
It's concerning and we want itto be treated.
So first I wanna develop thismeasure so that we can, one, use
(21:12):
it to screen patients like inallergy clinics, and then also
look at this on a populationlevel, like in a nationally
representative sample, and seewhat other types of factors it's
associated with as well.
Um, and then.
After that, I want to developinterventions to like, like
(21:33):
brief treatments that could beused to, uh, like give patients
confidence in practicing skillsthat will reduce their social
anxiety.
and then in addition to workingwith patients and families and
medical providers, there's alsoa role for just society in
general and messaging that, likewe talked about before with
(21:57):
Karen, that like patients withfood allergies are not difficult
their condition is difficult,but them as a person is
Amanda Whitehouse, PhD (22:08):
Right.
Melissa Engel, PhD (22:08):
difficult.
Amanda Whitehous (22:09):
personalities, they're not behaving in a
difficult way.
there's a long way to go interms of society having
understanding of medicalconditions and what people's
needs meet might be.
Melissa Engel, PhD (22:19):
I think there's also a lot of
complexities, um, when it comesto like dietary preferences now
and sensitivities and just like.
Trend diets.
I mean, I was even at, um,dinner with some friends
recently and I had an extensiveconversation, um, about my food
(22:40):
allergies and the precautionsthat they were able to take and
the restaurant was great.
Um, but then some other peoplelike.
For a certain ingredient to beomitted.
Um, and, uh, they're then askedlike, oh, is it like an allergy?
And they're like, oh, it's justkinda like a sensitivity.
And then they're taking allthese allergy precautions for
(23:01):
everyone at the table when noneof these people actually had
food allergies.
So then it kind of, um.
I know, and I know from talkingto a lot of like kids and teens
that then it dismisses like the,the severity for people with
food allergy.
So I, it's really tricky and Ithink that there's like now so
(23:23):
many more choices in terms ofrestaurants and products, et
cetera, um, with special diets.
So like in, in some ways it'sbeen really helpful, but then in
other ways it's been sometimesmade more difficult.
Amanda Whitehouse, PhD (23:37):
Right.
It muddies the water for peoplewith severe food allergies and
celiac also.
Melissa Engel, PhD (23:42):
oh yeah, kids are just, everyone's just
difficult these days andeveryone has their like trend
diets and like, this is notreally a trend or a fad or
anything that anyone with foodallergies would choose.
Amanda Whitehouse, PhD (23:54):
So.
You're talking about treatmentand how this could inform, like
assessment and identifyingpeople for treatment and then
developing treatments.
Um, so I would assume then thatyou have visions of how this
could be put into action on alarge scale.
How schools and healthcareproviders, um, could incorporate
this into their work.
Melissa Engel, PhD (24:12):
For right now, I think it would be great
if healthcare providers justasked about like the social
impact of food allergies.
Open-ended questions?
Like are there activities orsituations that you avoid
socially, because of your foodallergies or like.
Do your friends know about yourfood allergies?
How does having food allergiesimpact your social life?
(24:35):
And I mean, for younger kids,you could tailor down that
language developmentally.
But just like to, to kind of geta sense of like, what are the
ramifications of this?
And are these patients avoidingthings unnecessarily?
Are they.
Able to speak up to people abouttheir food allergies.
(24:56):
Are they carrying theirepinephrine even when they're in
different social situations?
Do their friends know how to usetheir epinephrine, et cetera?
Um, but I would love to developlike a brief like, uh,
intervention.
It could be administered in, ina few sessions, uh, too.
Patients with food allergies andideally could be not just like,
(25:21):
so I'm in an academic medicalcenter, which is great, but the
majority of patients with foodallergies aren't necessarily.
Being treated at an academicmedical center or have easy
access to like ongoing treatmentapart from like annual visits,
and working in all differentsettings and even like people
(25:43):
working in school settings, um,that would really be like an
exposure based.
model to have kids and teenagersbeing like practicing exposures
of being in social situations inwhich their allergies are
apparent, and handling them withconfidence and learning that
(26:06):
they can handle it.
Amanda Whitehouse, PhD (26:08):
Yeah.
How beautifully would that workin a school, right?
With so many opportunities toincorporate that in real life
settings with staff and adultsupport and making it so safe,
right?
So many adults around to makesure that the allergy part is
still managed safely.
Well, kids can, rehearse and,and practice these,
interventions for the socialaspect of these interactions.
Melissa Engel, PhD (26:30):
Yeah, and I think I would love to do this
like in a group.
Um.
Model.
Um, and I feel like it couldwork really effectively because
I've done, um, like socialanxiety groups for kids without
food allergies or medicalconditions, like more general
social anxiety groups for middleschool and high school, and I
(26:51):
think that that could be reallynicely adapted for food
allergies.
Amanda Whitehouse, PhD (26:56):
The idea would be that this, assessment
would be at the point of medicalcontact at the allergist office,
ideally, and then people couldbe identified who need extra
support and referred out totherapists who then already know
that this is the treatmenteffective based on the phobia of
anaphylaxis versus the socialanxiety piece this, this
individual is dealing with.
And then have treatments thatare, you know, evidence-based.
(27:19):
Address that it sounds so smoothand clean.
Is that the idea?
Melissa Engel, PhD (27:23):
Um, I mean, next ideas I would be smooth and
clean.
It's probably a bit messier inreal life, but, um, I know that
there's, uh, there are somegreat exposure based treatments
have been recently developed,um, by Katherine Dahlsgaard
colleagues for.
like the fear of anaphylaxismore specifically, and they
(27:45):
could, I could also see therebeing like modules or like
adaptations, um, for general,like food allergy, anxiety
treatment.
And then you could, based onassessments and um, interviewing
patients and families, you couldsee, okay, does this patient
need, um, like one of thesetreatments or like all of these
(28:05):
treatments, for example, becauseyou could.
Target both of them
Amanda Whitehouse, (28:11):
Absolutely, and as you described, a lot of
people will have both, but it'sunderstanding that clearly, or
if one is presenting.
More problematic at a certainmoment in time for that person.
And I will link for people whoare listening in the show notes,
if you missed it, Dr.
Katherine Dals guard was on theshow talking about, um, her, you
know, proximity challenges forthese specific phobias, um,
related to the fear of theallergen and the anaphylaxis.
(28:34):
So one arm of this is developed.
Melissa Engel, PhD (28:36):
I am a very big fan of Catherine and her
work, so.
Amanda Whitehouse, PhD (28:41):
yeah.
Melissa Engel, PhD (28:42):
I think that it, the more people that are
caring about this and trying todevelop innovative treatments,
the better and to collaborate onthem we wanna, create the most,
seamless and, hopefully briefand cost effective treatments
that we can readily give out topeople and make accessible.
(29:02):
And I know that, Catherine andcolleagues have also developed
the scales of food allergyanxiety that's really focused on
this, uh, fear of anaphylaxis.
And I think it would be reallycool to develop, um, an
instrument that uses.
That and the social piece sothat they're together as well as
(29:23):
any other, um, core fearsrelated to food allergies that
have also not been addressed.
Because Yeah, I'm saying that inaddition to the fear of
anaphylaxis, there's this fearof negative social evaluation,
but I mean, maybe there'sanother fear that we're also not
capturing, and it would be greatto have like one brief and
(29:44):
validated measure that could beused.
Amanda Whitehouse, PhD (29:46):
Yeah, to combine all of those and build
on the research that's alreadydone.
Yeah.
Melissa Engel, PhD (29:50):
And it's free because that's, um, another
thing
Amanda Whitehouse, PhD (29:54):
Right.
Melissa Engel, PhD (29:54):
want the things that I create to be
readily available to people inall settings.
Amanda Whitehouse, PhD (30:02):
We all appreciate that.
Absolutely.
So with the time that we haveleft, just tell us what's your
hope for the future of yourcareer.
You'll be finishing your postdocplacement, um, and then do you
have goals, any inclination ofwhere you might end up?
Melissa Engel, PhD (30:15):
Um, yeah.
Well, I am hoping to.
what I do now in a sense of likehaving a joint, um, clinical and
research career.
Um, and I want it to betargeted, like and focused on
food allergy.
So, research, on identifying thepsychosocial challenges that
(30:36):
patients and familiesexperience, and then developing
interventions So hopefully doinggroup designing, group programs,
as well as individual therapyand also doing a lot of
education, like that's somethingwe do a lot of at CFAAR.
That's really important to me.
So, whether that's high schoolstudents or college students or
(30:58):
medical students or othermedical professionals as well as
providers in the community.
Adolescence is a reallyimportant, um, focus of mine,
and that is something that like,no matter what I do, I want to
make sure.
I keep going with that line.
Um, and something that I thinkis really interesting is that
(31:20):
the messaging that I've seen inthe literature and just heard in
food allergy communities is thatit gets easier, um, as.
People get older, I think that alot of that is because like the
burden of food allergymanagement just transitions as
it should from, um, parents andcaregivers to their adolescent
(31:42):
young adult children.
But then all of these challengesthat are unique to adolescents
and young adults, haven't reallybeen spotlighted.
So that's something that Idefinitely want to continue to
work on.
Amanda Whitehouse, PhD (31:56):
Well, we're so appreciative to have
you in the field and in the foodallergy community doing all of
this work for us and we'll haveyou back.
I know you've got other papersand things in the works that my
audience will wanna hear abouttoo, so please come back and
we'll be following your worktoo,
Melissa Engel, PhD (32:09):
I'd love to be on again.
I'm so grateful to Dr.
Melissa Engel for joining metoday and sharing her important
work.
This conversation feels veryhopeful for me, like the
beginning of a much needed shiftin how we talk about
conceptualize and respond to themental health aspects of food
allergies.
Here are three action steps youcan take right now after
listening.
Number one, check the show linksor go back to find episode 32,
(32:33):
which is the one we mentionedtoday with Dr.
Katherine Dahlsgaard.
Diving into the phobia and fearof anaphylaxis piece that is
important and important todistinguish from the social
anxiety piece that we talkedabout today.
Number two, you can follow Cfar,C-F-A-A-R, the Center for Food
Allergy and Asthma Research, tostay up to date with their
(32:53):
latest studies, events, andeducational efforts.
And number three, if today'sepisode resonated with you,
please share it with anotherfood allergy parent family or
friend who might benefit fromfeeling seen in this discussion.
Spreading awareness is one ofthe best ways to make sure that
this work gets the attentionthat it deserves.
Thank you so much for listening.
(33:14):
the content of this podcast isfor informational and
educational purposes only, andis not a substitute for
professional medical or mentalhealth advice, diagnosis, or
treatment.
If you have any questions aboutyour own medical experience or
mental health needs, pleaseconsult a professional.
I'm Dr.
Amanda Whitehouse.
Thanks for joining me.
And until we chat again,remember don't feed the fear.
Welcome to the Don't Feed the Fear podcast, where we
dive into the complex world offood allergy anxiety.
I'm your host, Dr.
Amanda Whitehouse, food allergyanxiety psychologist and food
allergy mom.
Whether you're dealing withallergies yourself or supporting
someone who is, join us for anempathetic and informative
journey toward food allergy calmand confidence..
(00:22):
Welcome back today on Don't FeedThe Fear.
I'm joined by Dr.
Melissa Engel, a psychologistand researcher who recently
published a groundbreaking paperthat introduces a model for
social anxiety related to foodallergies.
While many of us living thisreality have always known that
social anxiety is a verydifferent experience from the
fear of exposure to ourallergens or anaphylaxis, the
(00:43):
scientific literature hasn'treally caught up until now.
So in our conversation, Dr.
Engel explains to us why thisdistinction really matters how
under researched the mentalhealth aspect of food allergies
is compared to other medicaldiagnoses and the hope that this
new framework will lead toscreening measures,
evidence-based treatments andtools that truly address the
(01:04):
challenges that families andindividuals are facing.
Amanda Whitehouse, PhD (01:07):
Dr.
Engel, i'm so excited to haveyou here to talk about your work
in the overlap of food allergyand allergic diseases and mental
health constructs, and your newpaper, which was just published
at the beginning of this month.
Thanks for joining us.
Melissa Engel, PhD (01:20):
Thank you so much for having me.
I'm excited to be here.
Amanda Whitehouse, PhD (01:23):
Can you tell people, what your,
professional focus is now, andhow you got into the world of
food allergy research?
Melissa Engel, PhD (01:29):
Yeah, absolutely.
So I am currently In my secondyear of a two year postdoctoral
fellowship in psychology atLurie Children's Hospital in
Chicago, which is the Children'sHospital of Northwestern, and
I'm in the center for FoodAllergy and asthma research at
Northwestern, which is alsoknown as cfar.
(01:52):
Um, and my work is like halfresearch and half clinical, so
my time is.
with patients with a variety ofmedical conditions.
And then the rest of my time isspent doing research at cfar.
And that is really on, um, themany psychosocial difficulties
that patients with foodallergies may face.
(02:15):
And I originally got into thiswork.
Based on my own experiencesgrowing up with food allergies,
I never intended to go into thisfield or to really do anything
with food allergiesprofessionally, but as I began
graduates.
Goal for clinical psychology andlearned more about pediatric
(02:39):
psychology and how psychologywas so integrated into so many
other medical specialties.
I noticed this huge gap, um,when it came to food allergy,
and so I decided to go back tothat route and what I knew
firsthand.
well.
Um, and so kind of combined likemy own experience working with
(03:02):
patient organizations throughlike volunteer type roles for
several years and just my ownexperiences growing up and then
my professional training, um,with many, many years of
graduate school in clinicalpsychology.
Amanda Whitehouse, PhD (03:18):
Some of the kids do the teen counselor
programs, with advocacyorganizations, did you start
that young and then get backinto it,
Melissa Engel, PhD (03:24):
Yeah, I was involved when I was a kid
actually.
One of the, I guess, highlightsof my very early career was when
I was in fifth grade and I did,The Kids Congress on Capitol
Hill, FARE was formerly FAAN andit was a fan kids Congress on
Capitol Hill.
And, um, Barack Obama was mystate senator, so I got to lobby
(03:48):
to him, um, about food allergylegislation.
So that was pretty cool.
And at that point I thoughtmaybe I would go into politics,
um, that never went anywhere.
Um, but I was in the teenadvisory group when I was in
Mills.
School and high school, um, andhelped out with some of the
programs at like the nationalconferences.
(04:10):
And then I, I pretty much likepaused in college because I was
busy with.
and education and everythingelse that comes with that.
And then once I entered graduateschool and had known I wanted to
do pediatric psychology again,had no interest in going back to
(04:31):
food allergy.
Um, fair actually reached out tome, um, to ask to help with
their teen engagement at thestart of the pandemic as, um,
you know, everything was.
Very different in early 2020.
Um, and that led to me gettingvery involved and having like
(04:52):
frequent zoom meetings withteens with food allergies and
then realizing, um, one that Iabsolutely love this, and two,
that there was so much need forwork in this space.
And just like looking at theexisting research and, and a
variety of other chronic medicalconditions compared to food
allergies, the um.
(05:13):
The mental health research andfood allergies and, um, clinical
care provided, it is prettysparse.
so then I'm like, okay, this iswhat I'm going to do for the
rest of my life, presumably.
Amanda Whitehouse, PhD (05:26):
Well, I'm so glad you did because you
know I asked that'cause I want.
People to understand that youreally know this from every
angle inside out.
You know, the clinical angle,the research angle, all
directions that are important toconsider combined into the
knowledge that you bring to thetable.
And I, I wanna talk about yourresearch, but I'd be curious
first, about what your clinicalwork looks like
Melissa Engel, PhD (05:46):
yeah, of course.
Um, so my clinical work is, um,a variety because, um, I'm in,
so I'm in my last year oftraining, um, as a postdoctoral
fellow, and I see patients witha variety of chronic and acute
medical conditions as well aspatients, um, without medical
(06:08):
conditions, but just, um,anxiety disorders, depression,
et cetera, like.
Children through adolescents,um, and sometimes young adults.
Um, and I see patients who arehospitalized inpatient, um, as
well as more patients in inoutpatient setting.
And I have some patients withfood allergies or asthma, um, as
(06:32):
well as patients with a varietyof other.
Chronic medical conditions like,um, type one diabetes, epilepsy,
um, gastrointestinal conditions.
It really varies.
Amanda Whitehouse, PhD (06:47):
What is the.
Difference.
Difference in being an effectivepsychologist to someone when
it's related to medicalconditions versus things that we
would think of as more purelyor, or you know, wholly mental
health based.
Melissa Engel, PhD (07:03):
That is a really good question, medical
conditions influence your,physiological symptoms.
So you often have that overlap.
And then there's a lot ofself-management behaviors that
are required to stay safe, um,or manage conditions
appropriately.
They.
Can be difficult.
Um, there's oftentimes adherencedifficulties, um, social
(07:27):
difficulties with speaking upand self-advocacy, especially
for kids and teenagers who, um,necessarily wanting to do that
because they just want to.
quote unquote be normal and fitin.
Um, and there also is just likethis extra layer that other
people don't experience.
(07:48):
Um, then when, when it comes toanxiety, which is what I see a
lot of the times, I think thatsomething, especially in in food
allergies that I hear is thatthe, like some level of fear is
so adaptive.
To stay safe and, um, with some,like other fear, like being
(08:10):
scared of the dark or scared of,um, an animal that you would be
unlikely to encounter or otherlike very improbable things, um,
like managing something likefood allergies or other medical
conditions does require a lot ofvigilance and preparedness and
(08:31):
speaking up and like.
That, that level of fear ishelpful to some extent.
Amanda Whitehouse, PhD (08:38):
Right, right.
Because the very things that youdo need to do that are
productive and that are helpfuland supportive and create safety
can become problematic if you dothem too much or too, too much
of an extreme or too often.
Melissa Engel, PhD (08:50):
Yes, I.
Amanda Whitehouse, PhD (08:51):
It's tough to shoot, but that's how
you feel safe.
So you would just wanna do itmore often.
Melissa Engel, PhD (08:55):
Yes.
And I also think that sometimesthis understandably gets missed
by medical providers, um,because if they see that
patients are being reallycareful, for example, um, that
often gets reinforced.
Amanda Whitehouse, P (09:11):
Absolutely encouraged medical providers and
parents, I think will tend toreally get involved if they
perceive that a child is notbeing cautious, but they'll
praise and elevate, oh, they'reso responsible.
They got, they're mature sincesuch a young age, which is true
and can be good, but, um, Ithink it gets nurtured and
encouraged sometimes more thanis helpful.
Melissa Engel, PhD (09:33):
Yes, I would agree.
Amanda Whitehouse, PhD (09:36):
So let's talk about your new paper.
Food Allergy Related, socialAnxiety, novel Conceptualization
of an Important but OverlookedConstruct.
And I love that you wrote thispaper you and I were talking
beforehand about how you saidyou've been thinking about this
so long, and I was shocked whenI read your paper like, of
course this is the case, butit's not something that had been
(09:56):
established, professionally inwriting.
So please tell us about thatprocess of taking that from an
what to you was an obvious ideaand writing it and sharing it
with the community.
Melissa Engel, PhD (10:06):
Yeah, when I, when we were talking before
it, it's almost like comicalthat this, like if you talk to
anyone, but especially youngpeople with food allergies, this
is such a salient and obviousissue, yet it has not been in
the literature.
Um, so I've been wanting towrite something like this.
(10:28):
For several years and just with,um, all of the demands of
training and other projectshadn't gotten around to it.
And once I did, I was sothrilled that all of the
wonderful co-authors weresupportive of this idea so that
we could come out with this,with this paper and continue
(10:48):
this research in, in the future.
But I think something thatreally struck me was.
When, so since 2020, I've beenleading Teen Talks for Fair,
which is, a monthly virtual peersupport program for youth with
food allergies between the agesof 11 and 22.
(11:09):
and we meet monthly.
Between 40 and the, our recordwas 93 teens each month, and
it's just basically a peersupport program where they talk
about the difficulties they facein daily life, as well as
exchange tips, and even discusslots of non-food allergy related
(11:31):
things.
Like one time they werediscussing, um.
Like ranking Oreo flavorsbecause everyone in a certain
breakout room could have Oreos.
They were safe for theirallergies.
And I'm like, what?
What discussion question are youon?
And that was the, what they werediscussing.
Amanda Whitehouse, PhD (11:45):
Oh, what a normal conversation for them
to get to have.
They might not otherwise.
Yeah.
Melissa Engel, PhD (11:49):
Yeah.
Um, so anyway, I lead thisprogram and we always start with
polls and I think it was thethird anniversary of this
program, like three years.
Um, and I, it was birthday partythemed, so I made a poll, um,
about what parts of like.
(12:09):
What aspect of attending abirthday party is like the most
difficult and with respect tofood allergies, and there were a
variety of options to choosefrom, but one of them was like
being scared of having areaction.
Um, one of them was like wantingthe cake, but then looking so
good and like not being able tohave it.
(12:30):
And one of them was.
Just like being asked questionsabout like, why you're not
eating the cake, or just likefearing being negatively
evaluated or perceived asdifferent or difficult or overly
cautious or things like that.
Um, for not eating the cake orpizza or whatever else that you
(12:51):
can't have because of your foodallergies.
And that third option was by farthe most chosen and that kind of
struck, stuck, uh.
Struck me as like evidence thatlike, yes, this is actually a
thing.
This is not just imagination.
And for these teens with foodallergies on this, you know,
this was like a veryself-selected group of 60 or so
(13:16):
people who chose to attend this.
But for them, it really was notthe fear of having an allergic
reaction, but the fear of justthis, like being negatively
socially evaluated by others atthe birthday party for.
Turning down the cake for noteating anything, for bringing
their own cake, et cetera.
Um, and it was that one timewhere I'm like, okay, I have to
(13:40):
do work in this area because itneeds attention so that we can
improve things.
Amanda Whitehouse, (13:47):
Absolutely.
And people listening might notunderstand.
Why does that matter?
Why is it important to make thatclarification?
Melissa Engel, PhD (13:55):
Yeah.
Um, so I right now, like in, inthe past.
Few decades, but especially likein the last decade, there has
been so much more of a focus onanxiety and food allergies and
also just like on mental healthin general and people without
food allergies and um,especially in youth.
(14:15):
And that is great.
Um, and I'm so glad.
and mental health in general isbeing addressed in food allergy
because like when I was growingup and attending these
conferences, there wasabsolutely no, no
acknowledgement of this.
So we've made so much progress.
Um, and at the same time, a lotof times when people are talking
(14:38):
about.
Anxiety in those with foodallergies.
They're really talking aboutthis fear of an allergic
reaction.
and that is very true and veryprevalent and very important.
And at the same time, addressingthat fear is very different than
addressing the socialimplications.
(15:01):
So if you find out that someoneis as anxious with respect to
their food allergies, it'sreally important that you figure
out like what that fear or whatthose fears actually are.
Because you would treat them in,in very different ways.
Like if someone was fearful ofbeing in close proximity to
their allergen, but it wasdeemed safe.
(15:24):
By their allergist to do so.
Then you could practice havingthem, you know, be at a birthday
party sitting next to someonethat's eating something they're
allergic to, versus if they fearthe negative social evaluation,
you can practice like speakingup for yourself.
You can practice intentionallyeating different things around
(15:46):
other people or, having kind oflike a.
Scripts that you say when atrestaurants, for example, even
like some patients that I'veworked with, we practice like
calling places or like orderingat certain places.
When the fear is actually thatthey're being perceived as
(16:08):
difficult or that people likewon't understand them or will
dismiss them as opposed to likefearing that they're actually
going to have an allergicreaction.
Amanda Whitehouse, PhD (16:18):
Right, and it's one of those examples
of what we should do, but oftenis not automatic really to
listen and understand someone.
Let them express their fear andarticulate what's bothering
them, rather than assuming thatwe know what's going on and we.
Assuming we know what kind ofhelp they need.
'cause as you described, it'ssuch a different kind of support
and a lot of people, I wouldassume, and in my clinical
(16:39):
experience, need both, but atdifferent times, you know, they
might have a combination, butthe thing that's bothering them
right now might not be the thingthat pops up next month that
they're nervous about.
Right.
It would be a combination.
Melissa Engel, PhD (16:49):
Yes.
Yes.
And it could be different basedon just like who they're with or
like the context or, um, how oldthey are or so many different
factors.
A, a big one that I think abouta lot and hear teens talk about
a lot is dating.
Um, and then that there, there'sa contrast of like.
(17:11):
that someone could have anallergic reaction from kissing
someone who has consumed theirallergen.
Um, so that would be like thefear of reaction versus other
people.
And what I actually hear a lotmore of is like.
Being rejected for being likeperceived as difficult or like,
(17:31):
you know, having to takeprecautions when kissing or um,
only going to certainrestaurants that have good
allergy precautions and thingslike that.
Um, and actually with the teensI work with, we often joke
about, um, like the Karen memewhere Karen, like a few years
ago, was that, um.
(17:53):
that wanted to talk to themanager and is like demanding.
And um, we sometimes joke thatuh, sometimes people with food
allergies, um, are seen ascoming across that way, which is
unfortunate.
Amanda Whitehouse, PhD (18:07):
Right, because they're seen that way
and they feel that way, and you.
At it's a totally differentthing because a Karen is someone
who's unnecessarily making astink, and that's not anyone
with a food allergy, what I'veever seen them do.
Right.
Melissa Engel, PhD (18:18):
yes.
Amanda Whitehouse, PhD (18:19):
For the most part, people are afraid of,
again, the social perception.
How will this come across to thepeople?
Particularly we all remember howdating is so nerve wracking.
without food allergies in thepicture, it's all about how does
this person perceive me?
So I think that's such a goodexample of how both of those
aspects of the anxiety wouldcome into play.
But it's, I think, easier tocomprehend why this specific
(18:44):
social anxiety piece is soimportant, it's an important
thing at all ages, butespecially to teens as social
perceptions.
Melissa Engel, PhD (18:51):
Yeah, and like, just like thinking about
like the demands of effectivefood allergy management, like
carrying epinephrine, Askingquestions like speaking up, like
it, they're, they kind ofconflict with the, the, like
adolescent development andwanting to just fit in, wanting
(19:12):
to take risks, all those things.
So there's like this tension.
Amanda Whitehouse, PhD (19:17):
Yeah, there is, and it just highlights
how important it is to know whatyou're working with and know
whether you're a clinician orwhether you're a parent.
What's this?
Kid, or what am I as an adult,what's the actual problem or the
fear here in this situation sothat I can address it
accordingly?
And I know, for you, this isjust the beginning of future
work that you see because youwanna establish this so that you
(19:38):
can do lots of things with itmoving forward.
So tell us what you see in thefuture based on what you've
established here in this paper.
Melissa Engel, PhD (19:45):
Yes, I am.
I'm very excited to have thisout so that it kind of like
unlocks many new directions thatI can take this.
So I'd love to develop a measureand.
Starting to do that, um, thatproviders could use to screen
for food allergy related socialanxiety because the existing,
(20:07):
um, questionnaires concerninglike anxiety and food allergy
specifically are, are reallyabout this fear of allergic
reaction.
And so this isn't really beingcaptured, so we don't really
know.
What this looks like in, um,individual patients.
And also we don't know what itlooks like at scale, like how
(20:29):
big of an an issue is this.
And I also just wanna emphasizethat a certain level of social
anxiety is like normative.
And I mean like of course it'sgood to care to an extent what
people.
Think about you, and it's greatthat teens want to be normal,
(20:49):
for example.
but when it prevents'em fromengaging in like appropriate
allergen management or when thislike fear of being negatively
evaluated, prevents them fromengaging in social things,
that's when, um, it would.
It's concerning and we want itto be treated.
So first I wanna develop thismeasure so that we can, one, use
(21:12):
it to screen patients like inallergy clinics, and then also
look at this on a populationlevel, like in a nationally
representative sample, and seewhat other types of factors it's
associated with as well.
Um, and then.
After that, I want to developinterventions to like, like
(21:33):
brief treatments that could beused to, uh, like give patients
confidence in practicing skillsthat will reduce their social
anxiety.
and then in addition to workingwith patients and families and
medical providers, there's alsoa role for just society in
general and messaging that, likewe talked about before with
(21:57):
Karen, that like patients withfood allergies are not difficult
their condition is difficult,but them as a person is
Amanda Whitehouse, PhD (22:08):
Right.
Melissa Engel, PhD (22:08):
difficult.
Amanda Whitehous (22:09):
personalities, they're not behaving in a
difficult way.
there's a long way to go interms of society having
understanding of medicalconditions and what people's
needs meet might be.
Melissa Engel, PhD (22:19):
I think there's also a lot of
complexities, um, when it comesto like dietary preferences now
and sensitivities and just like.
Trend diets.
I mean, I was even at, um,dinner with some friends
recently and I had an extensiveconversation, um, about my food
(22:40):
allergies and the precautionsthat they were able to take and
the restaurant was great.
Um, but then some other peoplelike.
For a certain ingredient to beomitted.
Um, and, uh, they're then askedlike, oh, is it like an allergy?
And they're like, oh, it's justkinda like a sensitivity.
And then they're taking allthese allergy precautions for
(23:01):
everyone at the table when noneof these people actually had
food allergies.
So then it kind of, um.
I know, and I know from talkingto a lot of like kids and teens
that then it dismisses like the,the severity for people with
food allergy.
So I, it's really tricky and Ithink that there's like now so
(23:23):
many more choices in terms ofrestaurants and products, et
cetera, um, with special diets.
So like in, in some ways it'sbeen really helpful, but then in
other ways it's been sometimesmade more difficult.
Amanda Whitehouse, PhD (23:37):
Right.
It muddies the water for peoplewith severe food allergies and
celiac also.
Melissa Engel, PhD (23:42):
oh yeah, kids are just, everyone's just
difficult these days andeveryone has their like trend
diets and like, this is notreally a trend or a fad or
anything that anyone with foodallergies would choose.
Amanda Whitehouse, PhD (23:54):
So.
You're talking about treatmentand how this could inform, like
assessment and identifyingpeople for treatment and then
developing treatments.
Um, so I would assume then thatyou have visions of how this
could be put into action on alarge scale.
How schools and healthcareproviders, um, could incorporate
this into their work.
Melissa Engel, PhD (24:12):
For right now, I think it would be great
if healthcare providers justasked about like the social
impact of food allergies.
Open-ended questions?
Like are there activities orsituations that you avoid
socially, because of your foodallergies or like.
Do your friends know about yourfood allergies?
How does having food allergiesimpact your social life?
(24:35):
And I mean, for younger kids,you could tailor down that
language developmentally.
But just like to, to kind of geta sense of like, what are the
ramifications of this?
And are these patients avoidingthings unnecessarily?
Are they.
Able to speak up to people abouttheir food allergies.
(24:56):
Are they carrying theirepinephrine even when they're in
different social situations?
Do their friends know how to usetheir epinephrine, et cetera?
Um, but I would love to developlike a brief like, uh,
intervention.
It could be administered in, ina few sessions, uh, too.
Patients with food allergies andideally could be not just like,
(25:21):
so I'm in an academic medicalcenter, which is great, but the
majority of patients with foodallergies aren't necessarily.
Being treated at an academicmedical center or have easy
access to like ongoing treatmentapart from like annual visits,
and working in all differentsettings and even like people
(25:43):
working in school settings, um,that would really be like an
exposure based.
model to have kids and teenagersbeing like practicing exposures
of being in social situations inwhich their allergies are
apparent, and handling them withconfidence and learning that
(26:06):
they can handle it.
Amanda Whitehouse, PhD (26:08):
Yeah.
How beautifully would that workin a school, right?
With so many opportunities toincorporate that in real life
settings with staff and adultsupport and making it so safe,
right?
So many adults around to makesure that the allergy part is
still managed safely.
Well, kids can, rehearse and,and practice these,
interventions for the socialaspect of these interactions.
Melissa Engel, PhD (26:30):
Yeah, and I think I would love to do this
like in a group.
Um.
Model.
Um, and I feel like it couldwork really effectively because
I've done, um, like socialanxiety groups for kids without
food allergies or medicalconditions, like more general
social anxiety groups for middleschool and high school, and I
(26:51):
think that that could be reallynicely adapted for food
allergies.
Amanda Whitehouse, PhD (26:56):
The idea would be that this, assessment
would be at the point of medicalcontact at the allergist office,
ideally, and then people couldbe identified who need extra
support and referred out totherapists who then already know
that this is the treatmenteffective based on the phobia of
anaphylaxis versus the socialanxiety piece this, this
individual is dealing with.
And then have treatments thatare, you know, evidence-based.
(27:19):
Address that it sounds so smoothand clean.
Is that the idea?
Melissa Engel, PhD (27:23):
Um, I mean, next ideas I would be smooth and
clean.
It's probably a bit messier inreal life, but, um, I know that
there's, uh, there are somegreat exposure based treatments
have been recently developed,um, by Katherine Dahlsgaard
colleagues for.
like the fear of anaphylaxismore specifically, and they
(27:45):
could, I could also see therebeing like modules or like
adaptations, um, for general,like food allergy, anxiety
treatment.
And then you could, based onassessments and um, interviewing
patients and families, you couldsee, okay, does this patient
need, um, like one of thesetreatments or like all of these
(28:05):
treatments, for example, becauseyou could.
Target both of them
Amanda Whitehouse, (28:11):
Absolutely, and as you described, a lot of
people will have both, but it'sunderstanding that clearly, or
if one is presenting.
More problematic at a certainmoment in time for that person.
And I will link for people whoare listening in the show notes,
if you missed it, Dr.
Katherine Dals guard was on theshow talking about, um, her, you
know, proximity challenges forthese specific phobias, um,
related to the fear of theallergen and the anaphylaxis.
(28:34):
So one arm of this is developed.
Melissa Engel, PhD (28:36):
I am a very big fan of Catherine and her
work, so.
Amanda Whitehouse, PhD (28:41):
yeah.
Melissa Engel, PhD (28:42):
I think that it, the more people that are
caring about this and trying todevelop innovative treatments,
the better and to collaborate onthem we wanna, create the most,
seamless and, hopefully briefand cost effective treatments
that we can readily give out topeople and make accessible.
(29:02):
And I know that, Catherine andcolleagues have also developed
the scales of food allergyanxiety that's really focused on
this, uh, fear of anaphylaxis.
And I think it would be reallycool to develop, um, an
instrument that uses.
That and the social piece sothat they're together as well as
(29:23):
any other, um, core fearsrelated to food allergies that
have also not been addressed.
Because Yeah, I'm saying that inaddition to the fear of
anaphylaxis, there's this fearof negative social evaluation,
but I mean, maybe there'sanother fear that we're also not
capturing, and it would be greatto have like one brief and
(29:44):
validated measure that could beused.
Amanda Whitehouse, PhD (29:46):
Yeah, to combine all of those and build
on the research that's alreadydone.
Yeah.
Melissa Engel, PhD (29:50):
And it's free because that's, um, another
thing
Amanda Whitehouse, PhD (29:54):
Right.
Melissa Engel, PhD (29:54):
want the things that I create to be
readily available to people inall settings.
Amanda Whitehouse, PhD (30:02):
We all appreciate that.
Absolutely.
So with the time that we haveleft, just tell us what's your
hope for the future of yourcareer.
You'll be finishing your postdocplacement, um, and then do you
have goals, any inclination ofwhere you might end up?
Melissa Engel, PhD (30:15):
Um, yeah.
Well, I am hoping to.
what I do now in a sense of likehaving a joint, um, clinical and
research career.
Um, and I want it to betargeted, like and focused on
food allergy.
So, research, on identifying thepsychosocial challenges that
(30:36):
patients and familiesexperience, and then developing
interventions So hopefully doinggroup designing, group programs,
as well as individual therapyand also doing a lot of
education, like that's somethingwe do a lot of at CFAAR.
That's really important to me.
So, whether that's high schoolstudents or college students or
(30:58):
medical students or othermedical professionals as well as
providers in the community.
Adolescence is a reallyimportant, um, focus of mine,
and that is something that like,no matter what I do, I want to
make sure.
I keep going with that line.
Um, and something that I thinkis really interesting is that
(31:20):
the messaging that I've seen inthe literature and just heard in
food allergy communities is thatit gets easier, um, as.
People get older, I think that alot of that is because like the
burden of food allergymanagement just transitions as
it should from, um, parents andcaregivers to their adolescent
(31:42):
young adult children.
But then all of these challengesthat are unique to adolescents
and young adults, haven't reallybeen spotlighted.
So that's something that Idefinitely want to continue to
work on.
Amanda Whitehouse, PhD (31:56):
Well, we're so appreciative to have
you in the field and in the foodallergy community doing all of
this work for us and we'll haveyou back.
I know you've got other papersand things in the works that my
audience will wanna hear abouttoo, so please come back and
we'll be following your worktoo,
Melissa Engel, PhD (32:09):
I'd love to be on again.
I'm so grateful to Dr.
Melissa Engel for joining metoday and sharing her important
work.
This conversation feels veryhopeful for me, like the
beginning of a much needed shiftin how we talk about
conceptualize and respond to themental health aspects of food
allergies.
Here are three action steps youcan take right now after
listening.
Number one, check the show linksor go back to find episode 32,
(32:33):
which is the one we mentionedtoday with Dr.
Katherine Dahlsgaard.
Diving into the phobia and fearof anaphylaxis piece that is
important and important todistinguish from the social
anxiety piece that we talkedabout today.
Number two, you can follow Cfar,C-F-A-A-R, the Center for Food
Allergy and Asthma Research, tostay up to date with their
(32:53):
latest studies, events, andeducational efforts.
And number three, if today'sepisode resonated with you,
please share it with anotherfood allergy parent family or
friend who might benefit fromfeeling seen in this discussion.
Spreading awareness is one ofthe best ways to make sure that
this work gets the attentionthat it deserves.
Thank you so much for listening.
(33:14):
the content of this podcast isfor informational and
educational purposes only, andis not a substitute for
professional medical or mentalhealth advice, diagnosis, or
treatment.
If you have any questions aboutyour own medical experience or
mental health needs, pleaseconsult a professional.
I'm Dr.
Amanda Whitehouse.
Thanks for joining me.
And until we chat again,remember don't feed the fear.
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