Effect of Symptom Levels of Children's Food Allergy on Maternal Depression: A Cross-sectional and Cohort Study.

BACKGROUND: Maternal depression may have negative impacts on children's behavior and mental health. Childhood food allergy is a common health issue, yet its relationship with maternal depression remains incompletely understood. This study aimed to analyze the association between children's food allergy symptoms and maternal depression through cross-sectional and cohort studies. METHODS: This study selected a total of 580 children with food allergy and their mothers who met the inclusion criteria in Ganzhou Women and Children's Health Care Hospital from April 2015 to April 2022, evaluated the symptom levels of children's food allergy according to the guidelines, assessed the depressive symptoms of mothers using self-rating depression scale (SDS), and analyzed the relationship between the symptom severity of children's food allergy and the risk of maternal depression; at the same time, one-year follow-up of mothers without depression was carried out to measure the incidence of depression to further explore this relationship. RESULTS: The 580 children with food allergies in the cross-sectional study consisted of 365 (62.93%) males and 215 (37.07%) females, aged (8.98 ± 2.30) years, with 298 (51.37%) experiencing Level-Ⅰ, and 282 (48.63%) experiencing Level-Ⅱ. A total of 56 (9.66%) mothers suffered from depression, aged (42.74 ± 5.42) years. Adjusting for confounders including mother's age, education level, marital status, family income, comorbidities, history of allergies, family history of food allergies, history of psychiatric disorders, current smoking status, current alcohol consumption, current regular exercise status, childhood food allergens and food allergy categorization, the mothers of children with child food allergy symptom Level-Ⅱ were found to have a higher risk of depression compared with mothers with child food allergy symptom Level-Ⅰ, odds ratio (OR) = 2.025 (95% confidence interval (CI): 1.319-3.128, p = 0.001). In the one-year cohort study, 38 (7.25%) mothers had new-onset depressive symptoms. Mothers of children with a child food allergy symptom Level-Ⅱ had an OR = 2.165 (95% CI: 1.612-2.902, p < 0.001) for depressive symptoms compared to mothers with a child food allergy symptom Level-Ⅰ. CONCLUSION: Among children with food allergy symptom scores of Level-Ⅰ and Level-Ⅱ, higher levels were associated with a higher prevalence of depression in their mothers.

The Development of Age-Based Food Allergy Educational Handouts for Caregivers and Patients: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee.

BACKGROUND: Food allergy education is an ongoing process that must address unique safety concerns and psychosocial challenges at each developmental stage. Families require reliable information that is targeted to specific developmental stages to support the integration of food allergy management into daily life. OBJECTIVE: The purpose of this project was to develop age-specific, evidence-based patient education handouts with practical recommendations for managing and coping with food allergies at different developmental stages. METHODS: Handout content was based on: (1) practice guidelines for food allergy management; (2) literature addressing psychosocial and educational needs of patients with food allergy and their caregivers; and (3) clinical experience of the project team. Fifty-seven caregivers of patients (aged 0-21 years) with food allergy and 2 young adults with food allergy reviewed a draft of the handouts and completed an online survey to assess handout acceptability and usability and identify areas for improvement. Handouts were revised based on participant feedback. RESULTS: The majority of participants (79%) rated the amount of information in the age-specific handouts as "just right," versus "not enough" (9%) or "too much" information (12%). Sixty-three percent reported that they would be "very likely" to use the handouts as a resource and 35% "somewhat likely." Almost all participants (88%-100% by item) agreed that the handouts used elements of plain language writing and clear communication. CONCLUSION: Caregivers rated the age-based food allergy education handouts as understandable and useful. We anticipate that these handouts could be used during health care visits and directly accessed online by families.

Qualitative analysis of perceived impacts on childhood food allergy on caregiver mental health and lifestyle.

BACKGROUND: Approximately 8% of children have food allergy. Yet, little is known about how parents cope with the burden of this disease. OBJECTIVE: This study aimed to describe the perceptions of food allergy-related mental health issues of parents of children with food allergy. METHODS: Parents of children with pediatric allergist-diagnosed food allergy were recruited through allergy clinics and education centers in a large Canadian city. We used content analysis to identify overarching themes. RESULTS: We interviewed 21 parents with children (boys [13/21; 62.9%]) aged younger than 12 months to 16 years. Interviews averaged 47 (range 33-82) minutes. Most children were diagnosed as infants, and few (7/21; 33.3%) were monoallergic. About one-half (7/16; 43.8%) had a history of anaphylaxis. Parents of children with a single food allergy spoke of "accommodation and adaptation." In contrast, parents of children with multiple food allergies described "anxiety and isolation" and spoke of being "depressed" and "terrified" about leaving their children in the care of others who may not be equipped to handle food allergy. Many parents felt "overwhelmed and alone," especially if they lacked support from extended family and/or their social circle. "Fear for today, fear for the future" was commonly described by parents, although a tenuous symbiotic coexistence was developed, with parents stating "Food allergy management has become our normal." Finally, a small group of parents reported that "Bullying happens, but we are alone to cope with it." CONCLUSION: Multiple food allergies negatively affect the mental health of parents, in a variety of well-being domains.

Autistic-like behavioural and neurochemical changes in a mouse model of food allergy.

Food allergy has been suggested to contribute to the expression of psychological and psychiatric traits, including disturbed social behaviour and repetitive behaviour inherent in autism spectrum disorders (ASD). Most research in this field receives little attention, since fundamental evidence showing direct effects of food allergic immune responses on social behaviour is very limited. In the present study, we show that a food allergic reaction to cow's milk protein, induced shortly after weaning, reduced social behaviour and increased repetitive behaviour in mice. This food allergic reaction increased levels of serotonin (5-hydroxytryptamine; 5-HT) and the number of 5-HT positive cells, and decreased levels of 5-hydroxyindoleacetic acid (5-HIAA) in the intestine. Behavioural changes in food allergic mice were accompanied by reduced dopaminergic activity in the prefrontal cortex. Furthermore, neuronal activation (c-Fos expression) was increased in the prefrontal cortex and reduced in the paraventricular nucleus of the hypothalamus after exposure to a social target. We hypothesize that an intestinal allergic response regulates complex, but critical, neuroimmune interactions, thereby affecting brain circuits involved in social interaction, repetitive behaviour and cognition. Together with a genetic predisposition and multiple environmental factors, these effects of allergic immune activation may exacerbate behavioural abnormalities in patients with ASD.

Functional bowel symptoms, fibromyalgia and fatigue: a food-induced triad?

OBJECTIVE: Patients with perceived food hypersensitivity typically present with multiple health complaints. We aimed to assess the severity of their intestinal and extra-intestinal symptoms. MATERIALS AND METHODS: In a prospective study, 84 patients referred to our outpatient clinic for investigation of perceived food hypersensitivity were enrolled consecutively. Irritable bowel syndrome (IBS) was diagnosed according to the Rome III criteria. Severity and impact of bowel symptoms, fatigue and musculoskeletal pain were evaluated by using the following questionnaires: The IBS Severity Scoring System (IBS-SSS), the Fatigue Impact Scale (FIS), the FibroFatigue Scale (FFS), and visual analogue scales (VAS) for scoring of musculoskeletal pain. RESULTS: All but one patient were diagnosed with IBS, 58% with severe symptoms. Extra-intestinal symptoms suggestive of chronic fatigue and fibromyalgia were demonstrated in 85% and 71%, respectively. Neither IgE-mediated food allergy nor organic pathology could explain the patients' symptoms. Nevertheless, malabsorption of fat was demonstrated in 10 of 38 subjects. CONCLUSIONS: Perceived food hypersensitivity may be associated with severe, debilitating illness. The comorbid triad of IBS, chronic fatigue, and musculoskeletal pain is striking and may point to a common underlying cause.

Neural correlates of IgE-mediated food allergy.

Although many authors have considered the possibility of a direct interaction between food allergy and behavioral changes, the evidence supporting this hypothesis is elusive. Here, we show that after oral ovalbumin (OVA) challenge, allergic mice present higher levels of anxiety, increased Fos expression in emotionality-related brain areas, and aversion to OVA-containing solution. Moreover, treatment with anti-IgE antibody or induction of oral tolerance abrogate both food aversion and the expression of c-fos in the central nervous system (CNS). Our findings establish a direct relationship between brain function and food allergy, thus creating a solid ground for understanding the etiology of psychological disorders in allergic patients.

Mechanisms in adverse reactions to food. The brain.

Specific chemical mediator release such as histamine and the prostaglandins (PG2a or PGD2) associated with headaches has been found in a few patients who were repeatedly challenged with specific foods, using DBPCFC techniques.

Food intolerance in patients with chronic fatigue.

Intolerance to various foods is reported often by patients seeking evaluation for chronic fatigue, a common symptom in primary care practice. To assess the prevalence and significance of this phenomenon we studied 200 consecutive patients with chronic fatigue who were given a comprehensive medical and psychiatric evaluation. Intolerance to foods from at least three different groups was reported by 27 patients (13.5%). We compared these patients with 27 age- and gender-matched patients from the same cohort of fatigued patients. Physical examination and laboratory testing showed few abnormalities in either group. The two groups were similar with respect to the duration and severity of fatigue, lifetime depressive symptoms, and prevalence of current depressive disorders (67% vs. 63%) and anxiety disorders (11% vs. 15%). Patients with multiple food intolerance had more lifetime functional somatic symptoms (p < .05) and a significantly higher (33% vs. 7%) prevalence of somatization disorder (p < .025). These data suggest that intolerance to multiple foods is probably not a cause or the effect of chronic fatigue, but rather one of the manifestations of the somatization trait expressed in these patients.