A Practice Research Study of How Youth Understand and Manage Risks Associated With Their Food Allergy

Abstract

Aim
To explore how youth understand and manage risk associated with food allergy in everyday life, aiming to inform future advanced nursing and care initiatives.

Design
Qualitative study based on critical psychological practice research.

Methods
Data was generated through participant observation and informal interviews during a 2‐day camp with youth aged 18–23years (n = 10), diagnosed with food allergy in childhood. Data analysis used thematic analysis informed by a critical psychology theoretical framework.

Findings
Risk associated with food allergy is an integrated aspect of the youth life trajectories. The allergy clinic plays a crucial role in how they come to understand and manage risk. Paradoxically, knowledge of risk fosters safety as well as uncertainty. Bodily awareness plays a crucial role in managing food allergy, but minor bodily sensations can trigger anxiety and fear of anaphylaxis. Establishing routines emerges as a key strategy for managing risk, as routines reduce anxiety and facilitate participation in everyday social activities.

Conclusion
The study highlights the complexity of managing food allergy in the everyday life of youth. How risk knowledge is translated from the clinic into everyday life varies and impacts risk management strategies in different ways.

Implications for Profession and Patients
HCP must address both physical and psychosocial aspects of living with the risk associated with food allergy. Individually tailored risk communication that considers personal circumstances and experiences can help reduce anxiety and support strategies for managing food allergy in everyday life.

Impact
Integrating patients' everyday perspectives and risk management into healthcare fosters personalised care. Nurses and doctors should help patients bridge the gap between medical advice and its practical application, addressing both physical and emotional aspects of managing health risks.

Reporting Methods
The SRQR guideline for reporting qualitative research.

Patient or Public Contribution
Patient representatives were involved in developing the protocol, research questions and study aims.

Full text

Journal of Advanced Nursing, 2025; 0:1–12
https://doi.org/10.1111/jan.16858
1 of 12
Journal of Advanced Nursing
EMPIRICAL RESEARCH QUALITATIVE OPEN ACCESS
A Practice Research Study of How Youth Understand and
Manage Risks Associated With Their Food Allergy
BrittEgmose1 | DortheS.Nielsen2,3 | CarstenBindslev-Jensen1 | CharlotteG.Mørtz1 | LotteHuniche1,4
1Department of Dermatology and Allerg y Centre, Odense Research Centre for Anaphylaxis (ORCA), Odense University Hospital and University of
Southern Denmark, Odense, Denmark | 2Department of Clinical Research, Geriatric Research Unit, University of Southern Denmark, Odense,
Denmark | 3Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark | 4The Faculty of Health Sciences, Department of
Psychology, University of Southern Denmark, Odense,Denmark
Correspondence: Britt Egmose (britt.egmose@rsyd.dk)
Received: 5 November 2024 | Revised: 31 January 2025 | Accepted: 13 Februar y 2025
Funding: This study was conducted as part of a Ph.D. programme funded by the Odense Research Centre for Anaphyla xis (ORCA), Department of
Dermatolog y and Allergy Centre, Odense University Hospital, University of Southern Denmark and the patient organisation Asthma- Allergy Denmark. The
funders had no role in analysing the data or preparing the manuscript.
Keywords: anaphylaxis| conduct of everyday life| critical psychological practice research| food allergy| life- trajectory| nursing| risk| routines|
teenagers| youth
ABSTRACT
Aim: To explore how youth understand and manage risk associated with food allergy in everyday life, aiming to inform future
advanced nursing and care initiatives.
Design: Qualitative study based on critical psychological practice research.
Methods: Data was generated through participant observation and informal interviews during a 2- day camp with youth aged
18–23years (n = 10), diagnosed with food allergy in childhood. Data analysis used thematic analysis informed by a critical psy-
chology theoretical framework.
Findings: Risk associated with food allergy is an integrated aspect of the youth life trajectories. The allergy clinic plays a crucial
role in how they come to understand and manage risk. Paradoxically, knowledge of risk fosters safety as well as uncertainty.
Bodily awareness plays a crucial role in managing food allergy, but minor bodily sensations can trigger anxiety and fear of ana-
phylaxis. Establishing routines emerges as a key strategy for managing risk, as routines reduce anxiety and facilitate participa-
tion in everyday social activities.
Conclusion: The study highlights the complexity of managing food allergy in the everyday life of youth. How risk knowledge is
translated from the clinic into everyday life varies and impacts risk management strategies in different ways.
Implications for Profession and Patients: HCP must address both physical and psychosocial aspects of living with the risk
associated with food allergy. Individually tailored risk communication that considers personal circumstances and experiences
can help reduce anxiety and support strategies for managing food allergy in everyday life.
Impact: Integrating patients' everyday perspectives and risk management into healthcare fosters personalised care. Nurses and
doctors should help patients bridge the gap between medical advice and its practical application, addressing both physical and
emotional aspects of managing health risks.
Reporting Methods: The SRQR guideline for reporting qualitative research.
Patient or Public Contribution: Patient representatives were involved in developing the protocol, research questions and
study aims.
This is a n open access ar ticle under the terms of t he Creative Commons Attr ibution-NonCommercial-NoDer ivs License, whi ch permits use and d istribution in any me dium, provided th e original
work is properl y cited, the use is non- commercial and no mo difications or a daptations are ma de.
© 2025 T he Author(s). Journal of Advanced Nursing publishe d by John Wiley & Sons Lt d.

2 of 12 Journal of Advanced Nursing, 2025
1 | Introduction
Food plays a vital role in both our physical and mental well- being.
Beyond that, food is important in our social and cultural lives,
helping build relations with family, friends and being part of com-
munities (Mennell etal.1992). Social gatherings such as birthdays
and parties often centre around food. While food is a fundamental
aspect of human existence and a source of joy for many, this is
not always the case for youth with food allergy (FA). For them,
eating can be a constant challenge and a source of daily stress
(Vazquez- Ortiz et al. 2020; Polloni et al. 2 017). Ingesting even
a small amount of a food allergen can trigger allergic reactions,
ranging from mild rash to life- threatening anaphylaxis (Muraro
et al. 2014). Anaphylaxis is a serious systemic allergic reaction
that is usually rapid in onset and may cause death. Severe anaphy-
laxis is characterised by potentially life- threatening compromise
in the airway, breathing, and/or circulation and may occur with-
out typical skin features or circulatory shock being present. First-
line treatment for anaphylaxis is adrenaline (Muraro etal.2014;
de Silva et al. 2020). Recent studies have aimed to determine
whether oral, sublingual, or epicutaneous immunotherapy, as
well as biological treatments, are safe and effective for curing FA
(Macdougall etal.2021). Presently, the key strategies for manag-
ing FA include constant awareness of potential allergens, monitor-
ing for signs of allergic reactions and ensuring immediate access
to life- saving medications such as adrenaline auto- injectors (AAI)
(Muraro etal.2014).
Balancing risk associated with FA in youth life presents ongoing
challenges (Vazquez- Ortiz etal.2020; Egmose etal. 2024) that
lead to increased prevalences of mental health issues like de-
pression, anxiety and social isolation (Polloni and Muraro2020;
Rubeiz and Ernst2021; Shaker etal.2017). Constant risk assess-
ment and dietary restrictions significantly impact quality of life
(Nguyen etal.2023; Kubala etal. 2024) and daily stress levels
(Feng and Kim2019; Newman etal.2022).
This study was initiated in response to challenges faced by
healthcare professionals (HCP) at a specialised allergy clinic in
Denmark caring for youth with FA. The HCP included nurses
and medical doctors specialised in allergy. Nurses are an inte-
gral part of the HCP and play a crucial role in the specialised
care of youth with FA. Nurses contribute to advanced nursing
through their involvement in multidisciplinary collaboration,
working alongside specialised doctors within the clinic. It was
a common HCP observation that youth diagnosed with FA in
childhood encountered difficulties in managing everyday life
with FA. Research indicates that despite receiving healthcare,
some youth encounter significant difficulties in managing FA
in their everyday lives, such as overwhelming concerns about
severe allergic reactions, limitations on everyday activities and
excessive control with and avoidance of food items (Polloni
etal.2017; Rubeiz and Ernst2021). In comparison, some youth
seem to manage their FA and the risk of life- threatening reac-
tions in a balanced manner, while others engage in highly risky
behaviour (Vazquez- Ortiz et al. 2020). However, these differ-
ences and the reasons behind them remain unexplored. Further,
the HCP were critically curious about the impact of the health-
care services provided at the allergy clinic on the everyday lives
of youth. The study aims to fill these gaps by incorporating the
perspectives and experiences of youth who were diagnosed with
FA as children and have attended the allergy clinic regularly
over the years. By exploring how youth understand and manage
the risks associated with FA in their everyday lives, the study
seeks to inform future care initiatives for children and youth di-
agnosed with FA and their families.
2 | Aim
This study explores how youth understand and manage risk as-
sociated with food allergy in everyday life with the aim of in-
forming future advanced nursing and care initiatives.
3 | Methods
3.1 | Theoretical Framework
Critical psychology (Holzkamp2013; Dreier2020) was chosen as
the theoretical framework for investigating and analysing how
youth understand and manage the risk associated with FA in
their everyday lives. In critical psychology, individuals are con-
ceptualised as subjects to emphasise the societal nature of human
beings and the close ties between subjectivity and social practice.
Holzkamp (Holzkamp 2013) argues against the view of the per-
son as an isolated entity that develops and acts as the result of
a personality structure or biological traits. As subjects live with
societal and social constraints and opportunities for conduct-
ing their everyday lives it is essential to investigate first- person
perspectives to understand personal conduct in specific circum-
stances. Central theoretical categories thus include conduct of ev-
eryday life and agency (Holzkamp 2013). These categories help
explore how youth with FA understand and manage their every-
day lives, interact with others, carry out everyday tasks, pursue
interests and goals in life while dealing with the risk associated
with FA (Holzkamp2013). By employing a first- person perspec-
tive, it is possible to analyse how individual existence is mediated
by participation in different contexts. The core of the analysis
aims to identify relevant conditions that significantly impact the
everyday lives of youth with FA, what these conditions mean to
them and how their actions are subjectively reasoned. This analy-
sis of “conditions, meanings and reasons” assumes that objective
conditions and what they mean are fundamentally interrelated
with reasons for specific actions and therefore must be studied
as a coherent whole rather than as isolated units with external
connections (Mørch and Huniche2006).
3.2 | Design
As a methodological approach, critical psychological prac-
tice research is characterised by collaboration and participant-
centeredness with the aim to qualify professional practice (Mørch
and Huniche2006; Nissen2000). One way to achieve this aim is
by involving relevant HCPs as co- researchers (Nissen 2000). In
this study, a co- researcher group comprising three doctors and
four nurses from an allergy clinic was established and convened
regularly over 16 months. These co- researchers agreed to the im-
portance of exploring youths' understanding and management of
risk in their everyday lives. They contributed by raising pertinent
issues related to caring for youth with FA in the clinic, providing

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case descriptions and assisting in preliminary data analyses. The
perspectives of youth were investigated through a 2- day camp.
Three patient representatives from the research unit board of the
hospital (a youth and an adult with FA who were both patients at
the allergy clinic, and a parent of a child with FA) participated in
the development of the protocol, providing input and feedback on
the focus, research questions and aim of the study.
3.3 | Setting
Data was generated during a 2- day camp at a small countryside
venue, attended by youth diagnosed with FA (n = 10) and all au-
thors. The venue was chosen to inspire confidence among par-
ticipants as meals and refreshments were prepared by kitchen
staff knowledgeable about FA with buffet and single- serve op-
tions provided. Before the camp, the first author (BE) engaged
in email correspondence with participants to clarify allergies
and dietary needs and address any concerns. Apart from ex-
ploring the youth's perspectives on everyday life with FA in
group sessions, the setting allowed researchers to observe how
participants experienced and managed their risk during meals
and breaks (Spradley 1980), and how they presented and dis-
cussed risk associated with FA. No set schedule was provided
in advance. Participants' interests guided activities. For example,
when they addressed a need to see each other's emergency medi-
cation, an activ ity was organised where they showed and demon-
strated their kits. Additionally, they engaged in “walk and talk”
sessions in smaller groups to discuss topics that emerged during
the camp. Two authors (CBJ, GGM) knew participants from ap-
pointments in the allergy clinic, which fostered a trusting and
humorous atmosphere and facilitated open communication.
3.4 | Recruitment of Participants for 2- Day Camp
Recruitment of participants for the 2- day camp involved purpo-
sive sampling (Green and Thorogood 2018) of youth who had
received specialised healthcare at the allergy clinic during their
teenage years to represent a diversity in gender and types of al-
lergens (tree nuts, peanuts, cow's milk, hens egg, fish, shellfish).
Youth were identified through nurses and doctors working at the
allergy clinic in Denmark. Three authors (BE, CBJ, CGM) re-
ceived a list of eligible patients; 32 youth between 18 and 23 years
of age were selected and received written invitations to partic-
ipate, including information on the purpose and outline of the
study. Invitations were followed up by a phone call. A total of 10
patients (3 men, 7 women) agreed (Table1). A total of 10 patients
reported conf licting plans as the reasons for non- participation,
two declined without providing a reason, and 10 cancelled
1–3 days before the camp due to a COVID outbreak.
3.5 | Data Collection
The 2- day camp took place in March 2022. Data were gener-
ated through participant observation and informal interviews
and aimed to gain insight into how youth with FA understand
and manage risk associated with FA in their everyday lives, fo-
cusing on actions and subjective reasoning. According to crit-
ical psychology, is it possible to generalise from an individual
case (Schraube and Højholt 2019). All authors engaged in par-
ticipant observation during the camp. Inspired by Spradley's
nine dimensions (Spradley1980), participant observation was
conducted during all camp activities, including group discus-
sions, mealtimes and breaks. The research team had different
positions during these activities (Spradley 1980). For instance,
the researchers dined alongside the youth to facilitate dialogue
and observations regarding their perspectives, actions and
choices in that context compared to other everyday life situa-
tions (Spradley 1980). Field notes were written during activi-
ties and detailed immediately afterward (Emerson etal. 1995).
Informal interviews were conducted when possible, providing
a deeper understanding and detailed data about how the youth
understand and reason about the ways they manage risk in
everyday life. These interviews were also documented in field
notes. Observations and reflections were discussed among the
research team three times during the camp to identify areas
TABLE  | Characteristics of participants.
Participants (ID) Age/sex
Numbers of
different food
allergies (n)
Anaphylactic
reaction out of
hospital (n)
Age at diagnose of
food allergy ( y)
Adrenaline
autoinjector (n)
A20/M 2 1 < 2 2
B19/F 4 1 < 2 2
C21/M 1 0 < 2 2
D21/F 1 0 < 2 1
E21/F 1 0 < 2 3
F22/F 2 0 15 0
G22/F 2 0 14 1
H22/F 2 0 < 2 2
I22/F 2 2 < 2 2
J23/M 1 0 < 2 0

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needing further exploration. Email correspondence with partic-
ipants before the camp was included in the final data corpus.
3.6 | Data Analysis
The procedure for analysing the data were inspired by Braun
and Clarke's six- step thematic analysis (Braun and Clarke2006).
This theoretically flexible approach was chosen for its ability to
enhance transparency and detail, allowing the integration of
the critical psychology framework for a deeper analysis of the
youth's perspective (Braun and Clarke2006).
In Step 1, familiarity w ith the data was achieved through repeated
reading of field notes by the first author (BE) capturing initial
thoughts, emerging patterns and reflections related to the aim.
Then in Step 2, a line- by- line coding approach was employed to
identify and highlight meaning units within the texts. The codes
were presented to co- authors and co- researchers for independent
review and refinement, ensuring that multiple perspectives were
incorporated. A draft codebook was created, and the remaining
data were systematically coded. As new codes emerged, iterative
re- coding was conducted to ensure that key aspects of the partici-
pants' perspectives were accurately captured.
In Step 3, meaning units were organised into preliminary
themes with an analytic orientation towards conditions, mean-
ings and reasons (Mørch and Huniche 2006), each linked to
relevant data extracts (Braun and Clarke 2006). Preliminary
themes were presented to the co- authors and the co- researchers
for further analysis and to ensure consistency. The preliminary
themes were then reviewed and refined by grouping and re-
grouping the codes. A mind map was used to create an overview
of emerging themes and sub- themes, ensuring a comprehensive
understanding of how youth understand and manage FA risks
in various contexts.
In Step 4, all authors reviewed and refined the themes, identify-
ing core elements and reassig ning data extracts where nec essary.
In Step 5, final themes were defined and named, incorporating
central critical psychological concepts and illustrative extracts
from field notes. The final Step 6 involved writing a comprehen-
sive story presenting the main themes and their associated data
excerpts, ensuring the results reflected the study's aim. The an-
alytic procedure is illustrated in Table2.
3.7 | Ethical Considerations
The study was approved by the Danish Data Protection Agency
(ID: 22/8636), The Committees on Health Research Ethics (ID:
20222000- 19), and adheres to the Danish Code of Conduct for
Responsible Research (Pedersen et al. 2015). All participants
were informed verbal ly and in writing about the aim and content
of the study, confidentiality, participation being voluntary, and
their right to withdraw at any time. Participants were encour-
aged to contact the first author (mail or mobile) after participat-
ing in the camp if they felt the need. Data were stored and kept
confidential on a secure platform (Sharepoint). Any details that
could potentially identify participants have been anonymised.
TABLE  | Illustration of the analytic procedure.
Data Coding Sub- theme Theme
You are constantly on alert – the risk is there every day,
even though I haven't actually had an allergic incident.
It's something you are trained to be aware of (ID E).
Exactly, you overthink all the time. You have learned
what to watch out for… so you overthink about whether a
reaction might occur (ID G). Field note
The risk has become
part of life
Life- trajectories
with FA
Life- trajectories
with FA
All the food challenges have made me wiser about my
food allergy and have maybe made me less afraid of
things because I've had the chance to experience allergic
symptoms… and to feel that this is what happens. This is
how it feels (ID I). Field note
The oral food challenges
have made me wiser
about my FA
Translating
knowledge from
the clinic into
everyday life
Life- trajectory
with FA
I had eaten cake and had a severe reaction, and we
probably should have called an ambulance and used the
AAI, but I don't know why we didn't. But when do you
know it's severe enough? (ID B) Field note
The absence of real-
life experiences of
anaphylaxis
You're always asked if you have your AAI when you go
to a consultation at the hospital, and if you say you don't
have one, the HCPs start preaching. They go on about
whether I'm aware it can be dangerous and how reactions
can come quickly… they paint a worst- case scenario to
scare me… but I see no reason to get an AAI because I
don't believe the risk is that high, I haven't reacted since I
was very young, and I didn't die then, and the hospital is
within a short distance (ID J). Field note
The perceived actual
risk is not significant
enough to get an AAI
Straying from
medical advice
Life- trajectory
with FA

5 of 12
3.8 | Rigour and Reflexivity
Critical reflection on one's position as a researcher and the con-
ditions influencing the research process is vital (Green and
Thorogood2018). To ensure validity, shared data analysis involv-
ing all authors refined the research agenda, questions and analyt-
ical processes (Jootun etal. 2009). The first author, a registered
female nurse and PhD. student with experience in qualitative
research and clinical expertise in FA, possessed insider knowl-
edge of clinical practice. The co- authors (CBJ, CGM), both MDs
and professors, served as both researchers and clinicians for the
youth, which introduced potential preconceptions and blind spots
in understanding the perspectives of those living with FA, po-
tentially influencing their engagement with the data (Green and
Thorogood2018). To mitigate these issues, the researchers main-
tained a critical and reflective stance through ongoing dialogue
with co- authors (DN, LH), a nursing professor and a psychologist,
who had conducted qualitative research using critical psycholog-
ical approaches but had no clinical experience in FA. Their exter-
nal perspectives enriched data collection and analysis, fostering
a broader understanding of the findings. To enhance credibility,
the researchers discussed the main themes emerging from pre-
liminary analyses of observations and informal interviews with
co- researchers, who provided feedback on themes, theoretical
concepts and extracts, prompting necessary adjustments. From a
transferability standpoint, these findings apply to similar settings
caring for youth with FA. SRQR guidelines were adhered to in re-
porting this study (O'Brien etal.2014).
4 | Findings
The analysis resulted in the overarching theme of risk sub-
divided into three main themes: (1) Life trajectories with FA, (2)
Embodied risk in everyday life and (3) Routinisation for emo-
tional relief, each detailed in one or two sub- themes (see Figure1
for an overview). Themes are interwoven and show how youth
manage risk associated with FA in their everyday lives and how
their understandings and actions are subjectively reasoned.
4.1 | Theme 1 Life- Trajectories With Food Allergy
For the youth who participated in the camp, the risk of an ana-
phylactic reaction had become integral to their life trajectories.
They had grown up in the context of this risk since they were
initially diagnosed with FA, and the threat of a severe allergic
reaction was introduced. Two youths conveyed how the aware-
ness of risk impacts their everyday lives with FA.
You are constantly on alert – the risk is there every day,
even though I haven't actually had an allergic incident.
It's something you are trained to be aware of.
ID E
Exactly, you overthink all the time. You have learned
what to watch out for… so you overthink everything,
whether a reaction might occur.
ID G
Different kinds of narratives from the allergy clinic played a
part in the participants' understanding of risk and their choice
of actions. All the youth agreed that through specialised allergy
healthcare, they had gained important knowledge and medical
advice on the risk of life- threatening allergic reactions, how to
take precautions and treat with AAI. The information about
precautions and treatment was valued as life- saving and pro-
vided a sense of security. However, for some youth, living with
knowledge of risk had come with a pervasive awareness of the
potential for an allergic reaction in any situation, whether risky
or not from the perspective of the allergy clinic.
There was a story from the allergy clinic about a
young person who kissed someone who had just eaten
peanuts and then had a severe reaction… that scared
me, especially when I was a teenager, and I didn't
dare to kiss anyone… because I didn't want to die.
ID C
The youth discussed their varied experiences of how the HCPs at
the allergy clinic conveyed information on predicting, assessing
and minimising the risk of anaphylaxis. Some of them pointed
out that HCPs had focused on extreme scenarios, which had re-
sulted in anxiety and uncertainty, leading to self- imposed lim-
itations and restrictive management strategies in everyday life.
You always have to read everything [on product
labels] because there are so many things to watch out
for… it has been a part of your life since you were little.
You have learned that you need to be careful and that
it can be dangerous, so you are always a bit on alert.
ID E
4.1.1 | Translating Knowledge From the Clinic Into
Everyday Life
The information on risk and management strategies provided
by the allergy clinic was interpreted differently by the Youth in
terms of understanding and managing their FA. Some of them
found it challenging to apply clinic- based knowledge to their
everyday management of FA. The youth discussed whether oral
food challenges and instructions of AAI introduced at the al-
lergy clinic had taught them to recognise allergic reactions and
how to assess and treat the symptoms of anaphylaxis. For some
of the youth, especially the oral food challenges helped them
gain insight into how their bodies reacted and learned which
specific symptoms they should watch for. This experience and
knowledge were translated into everyday life in ways that made
them more confident and safe in recognising a potential aller-
gic reaction.
All the food challenges have made me wiser about
my food allergy and have maybe made me less afraid
of things because I've had the chance to experience
allergic symptoms… and to feel that this is what
happens. This is how it feels.
ID H

6 of 12 Journal of Advanced Nursing, 2025
Conversely, others struggled to translate knowledge from the
clinic into everyday life in productive ways. Clinic- based food
challenges were typically interrupted before anaphylaxis oc-
curred, leaving some youth unsure about recognising severe
symptoms or using A AI.
I had eaten cake and had a severe reaction, and we
probably should have called an ambulance and used
the AAI, but I don't know why we didn't. But when do
you know it's severe enough?
ID B
Despite being equipped with an understanding of severe allergic
symptoms and the use of AAI, the absence of real- life experi-
ences made some of the youth more uncertain and worried about
the risk of anaphylaxis. Several participants expressed a wish to
have experienced a severe reaction to mitigate their anxiety.
The HCPs have always stopped the food challenges at
the Allergy Clinic when I start vomiting and my eyes
get a bit swollen, so I've never experienced a blackout
or needed the AAI. I don't think it's been that bad,
I haven't feared for my life, but I still have anxiety
about it. The anxiety is with me all the time because I
know it can happen, but I don't know how it feels and
whether I would handle it correctly.
ID E
This gap between knowing and practical experience contributed
to persistent anx iety about anaphylaxis. For many youth, the un-
derstanding of risk was based on the knowledge and advice on
precautions provided by HCP at the specialised allergy clinic.
This knowledge and advice were then integrated into their ev-
eryday lives in a generalised manner. Thus the youth's interpre-
tations of risk were not based on experiences with anaphylaxis
but rested on their understanding of the information conveyed
in the medical context.
4.1.2 | Straying From Medical Advice
When youth with FA did not follow medical advice, they experi-
enced nurses and doctors often responding by emphasising the
seriousness of the risk involved. This tension was particularly
evident in discussions about the necessity of carrying an AAI for
anaphylaxis. While nurses and doctors stressed the importance
of always carrying an AAI, some youth questioned this need
based on their personal experiences and subjectively perceived
level of risk. The youth conveyed that during consultations, they
were often asked if they carried their AAI. When they admitted
they did not, nurses and doctors would shift the focus towards
worst- case scenarios, emphasising how quickly severe reactions
could occur. This approach was often perceived as an attempt
to scare them into compliance. However, some of the youth per-
ceived their risk as low.
You're always asked if you have your AAI when you
go to a consultation at the hospital, and if you say
you don't have one, the HCPs start preaching. They
go on about whether I'm aware it can be dangerous
and how reactions can come quickly… they paint a
worst- case scenario to scare me… but I see no reason
to get an AAI because I don't believe the risk is that
FIGUR E  | Overview of overarching theme, main themes and sub- themes.

7 of 12
high, I haven't reacted since I was very young, and
I didn't die then, and the hospital is within a short
distance.
ID J
This highlighted a gap between the nurses and doctors' medical
focus on potential risk and the youth's perception of their ac-
tual risk. Instead of fostering open dialogue, some youth experi-
enced that nurses and doctors often escalated their warnings by
stressing the risks and potential consequences of not following
medical advice. This approach created frustration among some
youth, who felt labelled as “risk- takers” for not adhering. They
felt that their personal experiences and perspectives were being
overlooked. This clash underscores the complex relationship be-
tween medical advice on risk management and the lived expe-
riences of youth, who desire a more nuanced conversation that
acknowledges their circumstances and subjective assessment
alongside professional advice.
4.2 | Theme 2 Embodied Risk in Everyday Life
The diagnosis of FA and the risk of anaphylaxis had heightened
the youths' bodily awareness. Their understanding of FA- related
risk was deeply tied to their bodily experiences in the clinical
setting, as well as in everyday life. Through these experiences,
they had learned that allergic reactions manifest physically,
making them highly attuned to bodily sensations that might in-
dicate the onset of an allergic reaction. This heightened body
awareness became a key factor in how these youths managed
FA. They had internalised that their bodies were sensitive to
allergens, which fostered constant uncertainty about whether
they had consumed the allergen they were allergic to. Any slight
bodily sensation could trigger anxiety and fear of an impending
allergic reaction. Anxiety could arise even when they were sure
they had not consumed anything they were allergic to.
During a break when snacks (cakes and fruit) are
served, one of the youth asks if others can get paranoid
and feel like their mouth might itch if they think there
is something they are allergic to, even when they
know they haven't eaten anything they can't tolerate.
ID G
All agree, and one says: If I eat something and feel a
slight tickle in my throat, my thoughts start to run,
and I psych myself up completely.
ID A
He explains that he begins to sweat and experience
minor bodily sensations, even though he knows he
has not eaten anything for sure. Another adds: Yes,
you can hardly think clearly; I freak out and feel like
I can't breathe.
ID F
Another confirms that she feels the same way. That's
why she only took the fruit and no snacks during the
break today, explaining that in her mind, she knows
the fruit is clean, just washed in water, and it helps
her control her thoughts and not be unduly aware of
whether she senses anything in her body.
ID E
This heightened bodily awareness often led to over attention
to bodily sensations, causing stress and emotional strain even
insituations where no allergen was present. The youth shared
a common struggle with the mere thought of an allergic reac-
tion triggering anxiety and a range of bodily sensations, even
if most had not experienced a severe allergic reaction in many
years. A common bodily sensation was itching in the mouth
or throat, which they had learned is one of the first symptoms
of an allergic reaction. To manage the anxiety, the youth ex-
changed various strategies, such as rinsing their mouths with
water, watching TV, going outside for fresh air, or calling their
parents. While they acknowledged that these actions would not
help in the case of anaphylaxis, they reasoned that these distrac-
tions helped shift their focus away from their bodily sensations.
If symptoms did not worsen, they considered the situation not
dangerous. This constant awareness of a severe allergic reaction
was a heavy burden affecting their conduct of everyday life in
multiple ways.
When it actually happens, like once every 10 years,
that I have a severe allergic reaction, I feel like those
alarm bells affect my everyday life more.
ID D
For some youth, it was often anxiety or uncertainty, and thus
their emotional state, that determined their choice of actions
insituations involving food. They cognitively assessed what
matters in their life, but it was their emotions that helped
them focus and select what was most important to them in
any given situation. For some of the youth, the anxiety was so
overwhelming that they sometimes skipped events involving
eating. For others, it was a matter of weighing out how much
the anxiety of a reaction would overshadow the enjoyment of
participating.
I almost set it up mathematically in my head,
weighing how much joy I get from going to the event
and eating the food compared to how much anxiety
I'll feel afterward. And I usually end up deciding
that the joy isn't worth how I'll feel after eating. So,
I either don't eat and wait until I get home or choose
not to go.
ID A
The youth's assessment of their opportunities and limitations in
concrete situations and thereby their agency in a specific context
was tied in with the experienced level of anxiety or uncertainty.
The assessment was also based on reflections related to what
had happened in the past and what could happen presently and
in the future. This created a conflict in their conduct of every-
day life between participating or not, and several of the youth
described a battle between emotions and cognition, where emo-
tions often determined their actions.

8 of 12 Journal of Advanced Nursing, 2025
4.2.1 | Navigating Risk in Everyday Life
The youth conveyed how they depend on others to manage
risks in different social contexts. They share the struggle to de-
termine who can be trusted and which places can be regarded
as safe. Safe or unsafe largely depends on the trustworthiness
of the individuals preparing the food and their knowledge of
FA and what to avoid in the food they serve. For some youth
at the camp, it was reassuring to be informed that the food did
not contain anything they were allergic to, and they did not
feel the need to double- check. They could simply enjoy their
meal and participate in the camp without being anxious about
a reaction.
It means a lot to me how the atmosphere is, how the
waiter treats me, how they welcome me when I arrive,
if they can relate to what I ask about, and if they
make an effort. Sometimes I've said, “I can't eat here
because you can't answer my questions,” and then
I've left because I felt it wasn't safe to eat there… but
here at the camp, she responded appropriately to my
allergy questions, and if she didn't have an answer,
she would find out. So, I felt safe.
ID G
Risk and risk management had become a part of their conduct
of everyday life, shaping their choices and actions across various
contexts. The youth discussed that striking a balance between
taking the risk seriously and not allowing it to dominate their
choices in social contexts was challenging for them.
I always know what I'm eating; I simply can't put
anything into my mouth if I don't know what it is. I
don't think I've ever done that… I've always, in one
way or another, known what I've eaten, and it requires
preparation, but I have to do it.
ID B
This also meant that spontaneous and new situations involving
food consumption were challenging because risk would be dif-
ficult to control. Restaurant visits, vacations and social events
were described as situations that pose challenges and were man-
aged in various ways to eliminate risk. For example, some youth
described that they always chose the same vacation destination
and restaurants if possible. Small cafes with different menus
every week were considered riskier than large restaurant con-
cepts, where the food content was labelled or always the same.
The youth did much preparation by checking the menu on web-
sites to see if there was something they could eat. For some, this
extra preparation allowed them to enjoy vacations and restau-
rant visits. However, for others restaurant visits were not an op-
tion and were entirely avoided because they found it too difficult
to manage the risk. The youth discussed that it could be conflict-
ing since they wanted to participate, but always had to assess the
event for safety.
I was invited to my girlfriend's uncle's housewarming
party. He's someone who cooks delicious food but
isn't a chef. I'm afraid to go. I don't feel comfortable
because I don't trust that he has 100% control and
knowledge of all the ingredients he puts in the food.
It wouldn't be safe for me. I wanted to go and see the
house and meet them. But I simply didn't because of
the food, so I declined the invitation.
ID A
For most of the youth, anxiety and bodily sensations were as-
sociated with situations involving food consumption. However,
some explained that the mere smell of peanuts triggered height-
ened bodily awareness. For instance, some feared going to the
cinema in case of others eating peanuts, preoccupying them
with monitoring potential allergic symptoms and stopping them
from enjoying themselves. They preferred watching movies at
home, a perceived safe environment.
4.3 | Theme 3 Routinisation for Emotional Relief
The youth's conduct of everyday life was characterised by specific
patterns of actions, routines and adjustments that were perceived
as necessa ry to control the risk in di fferent contexts. Reading prod-
uct labels and checking the content of food was a strategy that all
participants engaged in to assess the risk and whether food items
were safe to eat. These routines provided a sense of security and
reduced uncertainty. However, for some participants, the uncer-
tainty and anxiety lead to extensive routinisation, controlling and
lack of flexibility in the conduct of everyday life. One participant
reported that every evening he would review the product labels of
every food item as he was preparing his packed lunch.
Even if it's bread I used for my lunch the day before,
I still check the ingredients on the package, just in
case… Otherwise, I know that I'll be sitting in class,
and my thoughts might get out of control. My body
starts feeling all sorts of symptoms, and then I won't
be able to pay attention to the lesson.
ID A
Re- reading the product label had the significance of preventing
him from feeling anxious when consuming his packed lunch
at school the next day. Other participants related to this expe-
rience. They reasoned that deviating from this routine, that is,
if product labels were not checked, thoughts of ingesting some-
thing they could not tolerate would trigger anxiety of an aller-
gic reaction. By following the same routines everyday life was
relieved of the need to manage anxiety, enabling presence and
participation in social contexts. It became clear that this kind of
routine was viewed, not as a limitation, but as enabling partici-
pants' engagement in everyday social life.
4.3.1 | Establishing Routines From
Everyday Experience
Routines and actions that had proven effective in specific situa-
tions were perceived as mea ningful and safe , and were replicated
in similar situations across different contexts. The participants

9 of 12
had learned to understand and manage risk through participa-
tion and experience in social contexts.
I'm just used to never touching dessert. I might eat it
if it's something boring like vanilla ice cream because
it's rare that they mess that up… it's just become a
standard routine since I was little and had my first
piece of cake with nuts in it. I realized that is where
you usually find them, so I just avoid them altogether.
ID J
At the camp, all youth abstained from certain foods. Some did
not have the dessert served with dinner. They explained that they
always avoided desserts as they were considered too risky to con-
sume, based on prior experiences. Despite information about the
ingredients and the assertion that the dessert was safe for them
to eat, they would not deviate from this routine asserting that it
freed them of any nervousness about whether they would have an
allergic reaction or not. Other youth did taste the dessert, but as
the texture connotated peanuts or nuts, which invoked a feeling
of uncertainty, they refrained from eating any more.
We have experienced so many times that people say
there is nothing in the food that I can't tolerate, and
then there is. So you get nervous and uncertain, and
it's best not to eat it. It's just something you do to avoid
taking any chances.
ID I
Previous experiences, emotions and actions were closely linked
when the youth attempted to control risk, and they were fully
aware that their actions could be seen as limiting and might not
always be necessary. However, they did not wish to change their
routines and actions, as it would introduce uncertainty and a
loss of control. Engaging in well- known routines provided com-
fort and a manageable way forward.
Why change something that works for me? I'm used to
not eating dessert, I don't miss it, and it's safe that way.
ID J
4.3.2 | When Routines Fail
Despite their routines, some of the youth had experienced aller-
gic reactions of varying severity. Following an incident, they at-
tempted to regain control by creating new routines or adjusting
existing ones.
After the allergic reaction, which was so different
from the ones I was used to, I started to get really
scared because my body was reacting differently. I
wondered if it was now truly dangerous for me and
things like that, so I became really risk- averse and
checked all my food thoroughly to be sure.
ID A
Most of the youth experienced anxiety when either symptoms or
the severity of an allergic reaction were not recognisable. Then
routinization and adjustments became even more important, as
they provided relief to avoid the emotional confrontation and
having to deal with risk. Even though the camp was supposedly
a safe place, including allergen- free food and competent nurses
and doctors ready to treat, some participants still experienced
heightened stress and anxiety due to the lack of personal control
over the food being served.
I've found it really stressful to come to the camp
without knowing the menu in advance. I even sent
you an email asking about the menu, but you weren't
sure what we were going to eat… it might make me say
I don't want anything to eat (cries).
ID E
Why is that important?
BE
Because I don't feel safe when I don't know what the
food is beforehand.
ID E
I also think that if we knew the menu in advance, we
could prepare ourselves and not have to worry about
what we can't tolerate.
ID H
What kind of oil is used in the food?
ID E
Are there specific oils it shouldn't be?
BE
It doesn't really matter; I just need to know what kind
of oil it is. It's just the thought of it that stresses me
out. I usually do this at restaurants. And I will keep
thinking about it while we eat if I don't do it (cries).
ID E
Establishing routines was thus an active way of organising, in-
tegrating and conducting everyday life in such a way that the
risk and the various conflicting demands faced by the youth
could be reconciled. When routines could not be maintained, it
led to uncertainty. Actively exercising and maintaining control
was comforting. Controlling was not only aimed at reducing the
physical risk of anaphylaxis, but also at keeping anxiety at bay,
thus enabling participation in social life.
5 | Discussion
Our study highlights the paradoxical nature of having knowl-
edge about the risk associated with FA, as it simultaneously
fosters safety and uncertainty. Information, narratives, and
advice on FA conveyed in the clinic are crucial in how youth

10 of 12 Journal of Advanced Nursing, 2025
understand and manage risk. While clinical advice on precau-
tions and prevention of anaphylaxis is intended to provide secu-
rity (Muraro etal.2 014) and reduce anxiety, it has the opposite
effect for some youth. A heightened awareness of risk leads to
increased anxiety and uncertainty (Motet and Bieder 2 017).
Risk, by nature, involves unpredictable future events and comes
with uncertainty (Motet and Bieder2 017). As a result, the very
knowledge meant to empower and protect can also serve as a
reminder of the unpredictable aspects of FA, amplifying feel-
ings of uncertainty. This echoes research on adolescents' be-
liefs about FA (Newman et al. 2022). For some youth in our
study, understanding risk associated with FA fosters a sense of
control, which helps reduce anxiety. However, for others, this
knowledge becomes a source of unease as it emphasises the un-
controllable aspects of their environment and the ever- present
possibility of an allergic reaction. The paradox of reduction or
amplification of emotional stress aligns with existing research
on risk communication, which suggests that greater awareness
can lead to a deeper recognition of the limitations of control
(Motet and Bieder2017). Thus, risk knowledge creates a tension
between empowerment and discouragement, as individuals re-
alise that no amount of information can fully eliminate all risks
(Alaszewski and Brown2007).
Additionally, our findings show that translating knowledge and
experiences from the clinic into everyday life poses challenges
for youth with FA. While some found food challenges and AAI
instructions helpful, others felt less confident in how to make
this knowledge useful in everyday life. This points to a gap be-
tween clin ical knowledge a nd real- life experiences , leaving some
youth feeling uncertain and anxious about managing potential
anaphylactic reactions. Clinical knowledge alone may not trans-
late into confidence or competence in real- life situations (Lave
and Wenger2001). This mirrors results from a Scottish study
(Gallagher etal.2011) among youth with FA, which identified
key barriers to effective AAI use, including difficulty recognis-
ing anaphylaxis and uncertainty regarding when and how to use
an AAI. The importance of bridging the gap between clinical
knowledge and real- life experiences to ensure youth are better
equipped to manage anaphylaxis is supported by a study on su-
pervised AAI self- injection sessions (Shemesh etal.2 017). This
study found that these practical exercises not only reduced anx-
iety but also significantly improved preparedness for managing
allergic reactions.
Further, our study highlights that youth with FA develop a
bodily awareness of allergic reactions as part of how they navi-
gate everyday life. A signif icant finding is the extent to which in-
tense focus on bodily sensations contributes to anxiety. Constant
vigilance and the fear of an allergic reaction impose a consider-
able psychological burden, as the youth manage a perceived risk
that may not always be grounded in actual allergen exposure.
Notably, anxiety is often aligned with bodily sensations that
mimic early allergic reactions, such as itching of the mouth,
which they have been taught to recognise as a warning sign. The
emotional toll of constantly monitoring bodily sensations high-
lights the complex reality of everyday life with FA. Emotional
repertoires (von Poser etal.2019), defined as the range of emo-
tional responses and regulation strategies individuals use in dif-
ferent contexts, play a crucial role in how individuals manage
their emotional experiences and interact in everyday situations.
Our study showed that youth with FA have developed emotional
repertoires related to risk and food consumption throughout
their life trajectory. Food consumption is essential not only to
nutrition but to interpersonal relations and social participa-
tion (Mennell etal.1992). Although FA is a chronic condition
that generally remains asymptomatic if allergens are avoided
(Muraro etal.2014), our study points out that youth constantly
face the emotional aspects of risk associated with FA, as meals
play a crucial role across various social settings in everyday life
(Mennell etal.1992). A recent study in patients with FA states
that Avoidant- restrictive food intake disorder is an underrecog-
nized but treatable complication using a multidisciplinary ap-
proach (Patrawala etal.2022). Moreover, our study shows that
the increased body awareness among participants is a double-
edged sword: it is essential for managing their condition, but it
also contributes to anxiety and avoidance. Emotions and actions
are contextually embedded and relational, built on past expe-
riences, current circumstances and carry future expectations
(Holzkamp- Osterkamp 1991). Negotiation of participating in
social events and fearing allergic reactions leads to restrictions
of actions that inf luence social life and well- being. This aligns
with a study examining the psychosocial aspects of FA, which
showed that anxiety is frequently related to a specific situation
or fear of a specific situation and not to a specific personality
structure (Rubeiz and Ernst2021).
Finally, our study shows that youth with FA integrate routines
into their everyday lives to manage both the physical and emo-
tional aspects of risk for allergic reactions. Establishing an ev-
eryday routine allows the youth to avoid constantly questioning
and doubting every aspect of their actions (Holzkamp2013). The
routines become repetitive and systematic in an active effort to
create and maintain workable solutions to risk in everyday life
(Holzkamp2013). Routines provide a sense of secur ity and reduce
uncertainty and anxiety (Holzkamp 2013; Dreier2020) helping
youth to manage their everyday lives with greater confidence.
While other studies have described routines among individuals
with FA as restrictive and limiting (Polloni etal.2017; Martinez
etal.2024), our findings indicate that these routines can also be
enabling, as the integration of activities into routines across var-
ious areas of life ensures that what is important and necessary
can be achieved (Dreier2020; Holzkamp- Osterkamp1991). The
youth viewed their routines as paramount in managing anxiety
and ensuring safety, allowing them to participate in social life.
By sticking with well- known routines, participants could relieve
anxiety about potential allergic reactions (Dreier2020). This ex-
plains why the inability to maintain or change routines as neces-
sary can lead to loss of control, uncertainty and anxiety.
5.1 | Strengths and Limitations
The primar y strength of this study is its unique approach, rooted
in a critical psychology framework and developed through close
collaboration with the co- researchers (Nissen2000). To the best
of our knowledge, this framework has not previously been ap-
plied to the exploration of perspectives on everyday life with FA.
Although the youth with FA actively participated in the camp,
a limitation is that they were not included as co- researchers
due to time and practical constraints. Involving youth in areas
such as data analysis could have further enriched the results

11 of 12
(Nissen 2000). While the sample size may be regarded as
small, the 2- day camp setting offered participants the chance
to connect and establish confidentiality, thereby encouraging
the discussion of sensitive and personal topics. A significant
strength of this methodological approach was the social inter-
action among participants, resulting in rich and extensive data
(Spradley1980). However, the researchers' dual roles as health-
care providers may have influenced participants' responses, as
it could feel intrusive for them to disclose sensitive perspectives
(Green and Thorogood2018). As a result, they might have re-
frained from expressing critical opinions about the allergy clinic
and its impact on their everyday life with FA. Additionally, the
2- day camp design may have predominantly attracted resource-
ful youth, potentially limiting the diversity of perspectives rep-
resented. It is possible that those with fewer resources would
have been more comfortable participating in individual inter-
views, where they would not need to eat food or engage with
other youth. Furthermore, few participants had experienced
anaphylaxis, which may have influenced the findings compared
to if the majority had encountered real- life anaphylaxis.
6 | Conclusion
This practice research study explores how youth understand
and manage risk associated with FA in everyday life. Awareness
of risk is deeply integrated into the youth's life trajectories, sig-
nificantly mattering for how they navigate everyday activities.
Risk management strategies aim at enhancing safety while mi-
nimising anxiety. Although nurses and doctors offer critical
life- saving knowledge and advice about risk and risk manage-
ment, this information can also impose a pervasive awareness
of potential allergic reactions, leading to increased anxiety and
uncertainty. Youth differ in how they translate knowledge of FA
into everyday life and how they manage risk. Bodily awareness
and monitoring of bodily sensations are crucial for managing
risk, but can also result in anxiety and avoidance of potentially
risky situations. Youth develop routines to address both physi-
cal and emotional aspects of risk in everyday life. Thereby, the
results become significant to advanced nursing within the spe-
ciality of FA.
7 | Implications for Practice and
Recommendations for Further Research
Our findings underscore the importance of integrating the ev-
eryday realities of youth living with FA into clinical practice.
Advanced nursing plays a key role in this integration. Nurses
and doctors must adopt an individualised approach when
communicating risk, recognising that youth understand and
live by clinical knowledge in different ways. Equal attention
to physical and psychosocial aspects of living with FA is par-
amount, as heightened awareness of risks can lead to anxiety
and extensive monitoring of bodily sensations. Clinics should
include screening for mental health symptoms to reveal more
severe psychological symptoms that need professional coun-
selling. Nurses and doctors should guide youth in translating
clinical knowledge into strategies that enable rather than re-
strict everyday activities and social life, focusing on inspiring
confidence and reducing anxiety. Practical exercises, such as
supervised AAI injection, can help prepare youth to manage
the complexities of everyday life with FA. Future research
should explore the effectiveness of individually tailored com-
munication strategies and practical training for improving the
management of bodily as well as emotional aspects of every-
day life with FA.
Author Contributions
All authors meet the following criteria (recommended by the ICMJE-
https:// www. icmje. org/ icmje - recom menda tions. pdf): They contributed
to the study conception and design. All authors performed material
preparation, data collection at the camp and data analysis. The first
draft of the manuscript was written by BE, and all authors commented
on the versions of the manuscript and revised it critically. All authors
read and approved the final manuscript.
Acknowledgements
We thank the young adults for participating in the study and for allow-
ing us to gain insight into their everyday lives with food allergies.
Ethics Statement
According to Danish legislation, qualitative research studies are not
required to be trial- registered. Relevant fieldwork permissions were ob-
tained, and the study was submitted to the Ethical Committee of the
Region of Southern Denmark (Project ID: 2022200 0- 19). Additionally,
the study received approval from the Data Protection Agency in the
Region of Southern Denmark (ID: 22/8636).
Consent
This study adheres to the Danish Code of Conduct for Responsible
Research. All participants were informed verbally and in writing about
the aim and content of the st udy, confidentiality, participation being vol-
untary and their right to withdraw at any time.
Conflicts of Interest
The authors declare no conflicts of interest.
Data Availability Statement
The data that support the findings of this study are available on request
from the corresponding author. The data are not publicly available due
to privacy or ethical restrictions.
Peer Review
The peer rev iew history for this article is avai lable at https:// www. webof
scien ce. com/ api/ gatew ay/ wos/ peer- review/ 10. 1111/ jan. 16858 .
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