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Presently, health is viewed in a more capacious sense.

According to The World Health Organization (WHO), health is defined as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity."[2] Compared to decades before, healthcare practitioners are generally beginning to become more aware of the connection between psychological changes and diseases. Recent discoveries have proven that emotional processes play a big role in the pathophysiology of a disease. This can be supported by a statement made by Rosalind J. Wright; the evidence linking psychological stress to the expression of asthma and atopy continues to grow. The awareness of this relationship is giving a new manifestation to the idea of health and disease. Fields such as health psychology and behavioral medicine are beginning to draw attention from educational institutions and medical centers. Not only that, peoples views regarding their experiences of a disease are also starting to be acknowledged. Getting their cooperation would work as a double-edged sword; it does not only help make researches even more relevant, but it also helps them understand their disease even better. Unfortunately, despite the growing comprehension towards this matter; there is a highly-prevalent disease that is still mainly seen in a purely medical point of view. The psychological development of people, especially children, living with food allergy or anaphylaxis, hasnt been very much accentuated although this type of health problem is known to be increasingly predominant over the years. Tracing the neurocognitive development of a human being is a crucial measure to help further understand a disease such as food allergy. The first significant transition point of such development in most people is when they begin to attain their formal education. It is the period when children would normally begin exposing themselves to a greater network of people. A study suggests that how a child grows up is an indicator of how they would develop in the future. This strongly affects the next most important transition point in human beings, which is adolescence. Adolescents who grow up with normal health conditions are expected to be able to adapt with social and emotional needs well as compared to those who suffer from chronic diseases. The latter are required to juggle between managing their disease whilst coping with regular activities that they should be doing at that age. Despite that, most of the people suffering from chronic diseases would not actually portray that much of a difference to be realized with a glimpse of an eye. Even so, it is important to keep in mind that there may still be some parts in their development that are in a way affected due to the disease that they carry. According to what I understand from the materials that I have learnt from class, the developmental effects have patterns and flows. I shall discuss this matter near the end of this essay.

Some might find it hard to comprehend the fact that a disease such as food allergy can detrimentally affect peoples lives. I do have allergies myself, but I have never really known much about food allergy. It never occurred to me that food allergy can turn out to be very bad and I clearly didnt know that many people are suffering from this disease. Thus, I believe that before looking specifically into how food allergy affects people, it is best to actually understand what food allergy itself is along with its general mechanisms. Simply put, food allergy is defined as an abnormal response to food triggered by the bodys immune system. Food allergy should not be mistaken for food intolerance. Food allergy is caused by an immune system response while food intolerance is a reaction in the digestive tract. [3] What is known to be genetically responsible for food allergy is a trait known as atopy. Atopy refers to the genetic tendency to develop allergic diseases such as allergic rhinitis, asthma and atopic dermatitis (eczema)
[4]

. In simpler terms, atopy is the over-

reaction of the body to harmless substances. [5] Atopy promotes an excessive production of specific IgE antibodies that combats common environmental allergens. Such hypersensitivity reaction is branched into two, each known as type 1 IgE-mediated reaction and type IV-mediated reaction. The first type, which is type I IgE-mediated reaction, is caused when mediators such as histamine are released after the first sensitization, causing the symptoms that we see on people with allergies. The second one, which is type IV-mediated reaction is mediated by T cells and normally affects the gastrointestinal tract or the skin. The type that is associated with food allergy is the type I IgEmediated reaction. Food allergy is an atopic disease which is apparently triggered by food allergens. Typical food allergens, according to Dr. Hugh A. Sampson, include peanuts, tree nuts, seafood, eggs and milk; and unfortunately, the list still goes on. Out of all the food allergens, peanuts have made its way to the top of the chart. Cases of allergic reactions triggered by peanut consumption are rising dramatically all across the globe, even at places where there previously werent many cases reported. It is thought that this alarming rate has a connection with the increased intake of novel food over the years. Novel food is characterized as a type of food that does not have a significant history of consumption or is produced by a method that has not previously been used for food. Novel foods are currently widely available in markets in forms of thickeners and substitute ingredients. It is possible that there may be hidden ingredients in novel foods that trigger food allergy. While cases of allergic reactions are gaining the attention of people nowadays, sadly, there have not been many systematic records of past cases that are related to food allergy. The worst part is; anaphylactic reactions are often mistaken to be caused by asthma instead of food allergy. These factors make it difficult to deduce the reality behind the occurrences of food allergy.

As mentioned earlier, anaphylaxis is often thought to be associated with asthma. Anaphylaxis is indeed actually a critical form of allergic reaction. An anaphylaxis reaction is sudden, severe and can cause death. It involves crucial body systems, such as the skin, respiratory tract, gastrointestinal tract and cardiovascular system. Symptoms may develop in a short while, usually in the first hour of exposure to the allergen. Taken directly from my main reference, the symptoms include swelling of the lips, tongue, or throat, difficulty breathing, abdominal cramps, vomiting, diarrhea, circulatory collapse, coma and death. Thus it is important to administer adrenaline or epinephrine immediately into the casualty via injection at the thigh muscles to be diffused into the blood stream. This is an interesting point to me as during a Clinical Practice session I attended, I had the chance to learn how to use the Anapen, which is an adrenaline/epinephrine auto injector that is used to reverse anaphylactic shock. Although we know that food allergy is caused by the release of histamine and that anti-histamines are available, anti-histamines do not suit as a treatment for anaphylactic shock. Antihistamines work too slowly, far behind adrenaline and epinephrine. As to avoid this serious condition, certain measures have been advocated. People who are at risk are advised to read food ingredient labels, be aware of cross contamination (one of the ways is by making sure that certain types food do not mix with food that is to be consumed), stay attentive during social activities and keep an Anapen nearby in case of emergency. Nonetheless, it is undeniable that when it comes to avoiding certain types of food, situations can get complicated, especially when food allergens are not in their original forms, such as when they are made into emulsifiers or thickening agents. For the second half of this essay, I will be writing about the effects of food allergy, based on the materials that I have been given, lessons that I learnt in class and also my own perception and understanding. By that, I shall begin with what I personally think of when it comes to the thought of living with allergy. As I have mentioned previously, I have problems with allergy as well. While making researches and studies on this topic, I have come to realize that the type of allergy that I am suffering from is an atopic allergy. My mother used to tell me about how my late father had the type of allergy similar to what I have. I never really believed that allergies are inheritable, but this study has indeed proved to me that it is. Following a blood test that underwent when I was little, results showed that I am allergic towards pollens and dust mites. I could remember that when I got exposed to them, I would get bad asthma attacks that require me to be administered with nebulizer very so often. I also had a history of eczema which caused certain areas of my skin to itch very often. Despite that, I didnt have to strictly follow as many precautions. What I had gone through was frankly difficult for me to deal with, but those were nothing much compared to what people with food allergy have to go through.

In order to help investigate how food allergy affects peoples lives, health professionals carry out a questionnaire-based research called the Health related quality of life (HQRL) research. HQRL is a broad multidimensional concept that usually includes self-reported measures of physical and mental health. [8] Based on the main reference that I have, it was mentioned that those who suffer from food allergy have a poorer quality of life as compared to those who also have diseases such as insulin-independent diabetes mellitus (IDDM) or rheumatological disease. This would probably seem rather shocking at glance, as all the diseases mentioned look as if they would give out a more or less similar impact on peoples quality of life. However, if we were to look closely and think about what people with food allergy really have to live with, we will be able to realize that situations are indeed relatively tougher for them. For instance, people living with food allergy have plenty of restrictions, similar to people living with IDDM. However, what makes them different is, people suffering from food allergy would have to face a daily dose of anxiety when it comes to eating. At the end of one previous paragraph in this essay, I stated that things can get difficult for people with food allergy when food allergens are not in their original recognizable condition. There are quite a number of food allergens that are chemically modified into substances to be used in processed food. Ingredient labels are sometimes unclear and confusing. How food is prepared in factories, restaurants or stalls remain unknown most of the time. The main physiological effect that is can be seen with people who have of food allergy is anxiety. However, there are also differences on how food allergy sufferers perceive food allergy at different stages of life. This point, which was widely discussed in the lecture about this topic, is mainly what I will highlight next. I initially chose this topic to summarize on because I find the lecture session given by Dr. Audrey DunnGalvin very appealing. I was amazed by the detailed outcomes of HQRL researches that were explained during the lecture. I have come to understand that qualitative and quantitative aspects play each play a big role in this research. While qualitative research provides a complete, detailed description of the research topic, quantitative research focuses more in counting and classifying features and constructing statistical models and figures to explain what is observed.[9] As for this topic, the qualitative research on was basically divided into two general parts, which were evidences based on facts and feelings. Factually and statistically, adolescents are at the highest risk of fatality due to food allergy. When asked about what they feel generally about this, their general response shows that they feel that they are living with uncertainty. This is relevant based on the explanation I included about the presence of anxiety when dealing with food consumption. People, especially children and teens may respond negatively towards their condition, such as becoming anxious or avoidant, or even worse, become angry and learn how to take risks.

As I cited earlier, I shall be discussing the developmental patterns of people living and coping with food allergy. The developmental pattern is studied to listen to what children, teens and parents living with food allergy have to say, gather information on their coping strategies and highlight developmental trajectories and transition points. There is known to be three main themes that are indirectly derived based on the food allergy research; namely, living with uncertainty, living with difference and living with the rules. The theme living with uncertainty has been explained, in which it generally focuses on their anxiety towards choosing what food to eat. Living with difference explains the vivid socializing problems that the children and adolescents encounter. The excerpts from their experiences prove to me that they are facing problems with bullying. This promotes insecurity and the feeling of self-shame. Lastly, the theme living with the rules portrays how challenging food intake restriction is, which lead to constant battles between temptation and sticking to what they know they have to do. These themes efficiently describe the range of situations that food allergy sufferers have to face. How different ages of people react towards their food allergy mark distinctive contrarieties. Children less than 8 years of age basically rely on what is provided and instructed by their parents. They trust that their parents are doing a good job helping them handle their disease. This is the stage where they do not seem to rebel and would follow instructions fairly well. At 8 years of age, they begin to understand and become afraid of the effects of the food allergy that they have. As they get older, some of them have thoughts and attempts of breaking out of the food allergy chain, showing signs of risky behaviour. However, this is not true for some others as living with food allergy has instead caused them to become overly-anxious and paranoid. It is obvious that at this stage, they are beginning to choose either of the two extremes. Up till this point, I believe that I have elaborated on how a food allergic reaction is triggered in a purely biomedical term (the sensitization of IgE-mediated response) and how food allergy affects peoples lives. However, I have yet to include the biopsychosocial aspects that are known to initially contribute to the cause of the disease. Biopsychosociology is a study that relates to, or is concerned with the biological, psychological, and social aspects in contrast to the strictly biomedical aspects of disease.[10] An American psychiatrist named Dr. George L. Engel formulated the biopsychosocial model as he believes that if physicians wish to promote better treatments for their patients, they must be able to understand the nature of all biological, psychological and social interactions all together, instead of merely focusing on purely medical diagnoses and curing.

In the case of food allergy, a number of researches have shown a link between maternal stress and the sensitization of food allergy. The environment (including the prenatal environment) is thought to be able to bring effects to the anatomical development of a child. In the study of food allergy, it is found that maternal stress affects the levels of salivary cortisol. Cortisol is termed the stress hormone because it is secreted in higher levels during the bodys flight or fight response to stress and other stress-related changes in the body. [11] The increase of cortisol levels can cause an increase in immunity. Thus, when there is maternal stress, there will be prolonged cortisol secretion. This can negatively affect the developing Th1/Th2 differentiation of foetus and new-born babies, leading them to be more prone to allergic diseases. In a deeper biological sense, when there is excessive exposure to cortisol, the intestinal lining can eventually weaken and erode. This weakened intestinal barrier allows undigested food particles to cross from the intestines into general circulation. This causes the body to see these food particles as foreign invaders and alerts the immune system to attack.
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It is also seen that there are differences in the level of immune

reactivity between different genders. Females are more inclined towards a higher rate of immune response as compared to males due to differences in their HPA (hypothalamic-pituitary-adrenal) axis which reacts with reproductive functions such as menstruation. To sum up, the journey of completing this assignment has taught me something that I might not be able to fully comprehend before. I realise the link between learning behavioural science and the ability of treating patients in a more holistic manner. To me, the study of food allergy has proven that the investigation of all the biopsychosocial aspects can bring out a better understanding of the disease. This study is a perfect example or model for future biopsychosocial studies on other diseases. More people must be aware that diseases shouldnt just be treated in a plain medical sense but in every single area. The World Health Organization (WHO) advocated the ideal definition of health and it is time for us to take it seriously. Last but not least, I believe that if the findings of this study are made use by health professionals and students, more diseases can be treated better in a more patient-friendly way. (2922 words, excluding the references on the next page)

REFERENCES
1. Main references: Elsevier (2009). Advances in Food and Nutrition Research, Vol. 56 Lecture slide: Dr. Audrey DunnGalvin. Determinants of Health: Psychological Medicine using the example of Food Allergy Lecture slide: Dr. Audrey DunnGalvin. The Biopsychosocial Model in Clinical Practice

2. Health definition: http://www.who.int/topics/mental_health/en/

3. Differences between food allergy and food intolerance: http://foodallergies.about.com/od/foodallergybasics/f/intolerances.htm

4. Atopy definition: http://www.aaaai.org/conditions-and-treatments/conditions-a-to-zsearch/Atopy.aspx 5. Differences between atopy and allergy: http://www.theucbinstituteofallergy.com/patient-and-public/What-is-Allergy/Howdoes-allergy-develop/Atopy-versus-allergy 6. Novel food definition: http://en.wikipedia.org/wiki/Novel_food

7. Anapen: http://www.anapen.co.uk/

8. HQRL definition: http://www.cdc.gov/hrqol/

9. Comparing qualitative and quantitative research: http://www.experiment-resources.com/quantitative-and-qualitative-research.html

10. Biopsychosocial definition: http://www.merriam-webster.com/medical/biopsychosocial

11. Cortisol as stress hormone: http://stress.about.com/od/stresshealth/a/cortisol.htm

12. High cortisol and development of food allergy: http://www.integrativepsychiatry.net/food_allergies.html

MAIN POINTS HIGHLIGHTED IN THE ESSAY


General overview of the definition of health Reality of awareness about food allergy Overview of the developmental trajectories & transition points of people with food allergy Food allergy mechanisms and misconceptions Substances that may trigger food allergy Anaphylaxis Personal experiences with allergy Health related quality of life (HQRL) research on food allergy Basic (quantitative & qualitative) analysis regarding food allergy Themes associated with living with food allergy Specific developmental trajectories & transition points of people with food allergy The biopsychosocial model Relationship between maternal stress and the sensitization of food allergy Conclusion and suggestions