Gina Clowes thought the hard candy her son had just eaten was safe for his multitude of food allergies. The candy turned out to be a chewy variety that triggered a severe allergic reaction.
"You look at the clock and seconds are all taking a minute," said Clowes, who had given her son a shot of epinephrine to counteract the attack and was waiting for the reaction to subside.
"I was the one thing he could trust," she said. And, in this instance, "I goofed."
Trust can be a tricky concept for many individuals and families dealing with severe and potentially fatal allergies. Although doctors say some anxiety and fear is good because it promotes the vigilance required to be safe, a frightening allergic episode can heighten anxiety to the point where moving on seems impossible -- and even unwanted.
Clowes, founder of the community resource site AllergyMoms.com, said her son, now in second grade, still remembers the frightening incident. For a long time afterward, he repeatedly asked whether Clowes had read the nutrition labels on foods.
Going into anaphylactic shock is fast and scary. As soon as an allergen triggers the release of histamine molecules by the immune system, a person can experience itching, swelling, hives, trouble breathing, cramping, vomiting and diarrhea. A shot of epinephrine, or adrenaline, is the only effective way to manage an allergic reaction like this. Anaphylactic shock can be fatal if not treated in time.
"It's literally like being in a car accident," Clowes said. "You are drained, you are shaking to your core because your life was just in danger or you endangered another life."
The most common allergens are to foods, medication, insect stings and latex, according to the Food Allergy and Anaphylaxis Network. In the United States, food allergy is the leading cause of anaphylaxis, resulting in about 30,000 visits to emergency rooms.
Dr. Robert Wood, chief of pediatric allergy and immunology at Johns Hopkins Children's Center in Baltimore, said post-attack trauma depends on three factors: personality, severity of the attack and the circumstances of the exposure.
"A severe, life-threatening reaction will impact the most happy-go-lucky child," Wood said.
But experts note that fearful feelings after an allergic episode are normal.
"Anxiety peaks for everyone, and it should," said Jane Robinson, part of the department of pediatric clinical psychology at National Jewish Health in Denver. "It helps families to kind of mobilize for a while."
Concrete actions after an episode, such as identifying the trigger and avoiding it, speaking with a child's teachers or other caretakers about what to do in an emergency, refreshing medical supplies or getting a medical identification bracelet, can help the family move beyond the fear of another attack. Robinson said most families recover in about six to eight weeks.
But, while these actions can go a long way toward relieving some anxiety, "the psychological underpinnings of that are difficult to overcome," said Sloane Miller, a food allergy coach and advocate who's president of Allergic Girl Resources Inc. in New York. "So many social events are around food. ... Life can become very restrictive if you can't rebuild that trust."
Robinson said that after an attack, some families may switch to home-schooling their child, refuse to let them eat in restaurants and start to clean everything with disinfecting wipes.
"Maintained over time, anxiety can be harmful," said Robinson, who pointed out that children mirror adult emotions. "The child might become fearful, not wanting to eat any food or go to school."
In severe cases, particularly when the anxiety begins to interfere with other aspects of life, psychological counseling might be necessary to help a child get beyond the attack and put it in perspective.
"They have eaten a thousand times in their lives," Wood said. "This time is the anomaly."
In fact, anaphylactic shock is only responsible for about 200 deaths each year, according to the Food Allergy and Anaphylaxis Network. This is far fewer than the 30,000 that go to the emergency room because of anaphylactic shock and recover, but it underscores the dangerous nature of allergies. Learning to trust food, a caretaker or even oneself again can be a difficult process.
For a parent, accepting and addressing the risks associated with everyday life and moving beyond the attack is beneficial for them as well as for their child, particularly because children mirror adult emotions and fears. Ultimately, how families deal with these situations is highly individual.
"Some parents take the attitude that their child needs to live in the real world, that an attack is going to happen, just don't know when and where," Robinson said. "Others will tie themselves in knots to make sure it never happens."
Clowes recalled another incident in which her son had an allergic reaction when she kissed him after eating a candy bar and some pineapple, both of which he was allergic to.
"The only thing worse than giving your kids an EpiPen [epinephrine] is giving them one because you kissed them," Clowes said. "I could have a pity party ... but I'm not going to wallow in it. This is a very powerful message for kids. You do it and you move on."