In certain individuals, reactions to food may be psychological (Kelsay, 2003). This is a difficult type of ARF to diagnose because the mechanisms giving rise to such reactions are poorly understood. Individuals who are not confirmed to have ARF have higher rates of hypochondria, hysteria, somatization, and anxiety than those with ARF confirmed by food challenge. An individual who experienced a severe ARF may avoid the culprit food for fear of further reactions, and there is also some evidence that hypersensitiv-ity reactions to food may be triggered through central neural mechanisms so that, eventually, just the thought of ingesting the food can trigger allergic symptoms in the absence of antigen. Food allergy itself may lead to psychological distress, and studies of food allergic subjects report an altered quality of life for the individual and their family, with severe manifestations such as anaphylaxis resulting in a post-traumatic stress situation.
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