Associations between gender and health-related quality of life in people with IgE-mediated food allergy and their caregivers: A systematic review.

OBJECTIVE: Understanding factors that impact health-related quality of life (HRQL) is essential to inform personalised food allergy management. However, there are inconsistencies about the impact of gender on HRQL in food allergy. This review aimed to collate all investigations of the association between gender and total or subdomain HRQL scores of individuals with food allergy and their caregivers. DESIGN: This is a narrative systematic review. We descriptively synthesised and compared HRQL outcomes by participant and parent genders according to statistical and clinical significance. Study quality was assessed using the ROBINS-I, inclusive of all domains. Sensitivity analysis of non-interventional studies was conducted using the ROBINS-E. DATA SOURCES: A systematic search of Medline and Embase databases was conducted on 4 April 2022 and updated on 5 December 2023. ELIGIBILITY CRITERIA: Studies were eligible for inclusion if they reported original data on the association between any sex and/or gender and HRQL, as measured with any validated instrument, in populations with IgE-mediated food allergy. Interventional and non-interventional studies were eligible. RESULTS: A comparison of 34 eligible studies (10 interventional and 24 non-interventional) indicated females with food allergy (62.5% of studies of children, 83.3% of studies of adults) and mothers of children with food allergy (50% of studies of caregivers) experienced poorer self-reported baseline HRQL than their counterparts, notably in domains of physical, emotional or food anxiety-related well-being. Gender differences in child HRQL after food allergen immunotherapy were observed. However, selective reporting in included interventional studies meant the direction of this association could not be determined. The proxy-reported total HRQL of participants was not affected by caregiver gender, nor was caregiver HRQL likely impacted by child gender. CONCLUSIONS: Gender should be considered an important modifier of participant HRQL outcomes in food allergy studies. Purposeful exploration of HRQL in all genders is needed to fully understand the implications of this construct on the lived experience of food allergy. SYSTEMATIC REVIEW REGISTRATION: PROSPERO (CRD42022329901).

The experiences of mothers of children with food allergy: A qualitative study.

BACKGROUND: Food allergies adversely affect the quality of life of the child and family, as they require lifelong treatment and follow-up. This study aims to examine the experiences of mothers who have children with food allergies within the framework of the biopsychosocial-spiritual model. METHODS: This study, using a qualitative research design, was carried out with mothers of children followed up with food allergy in the pediatric allergy outpatient clinic of a university hospital between December 15, 2022 and January 05, 2023. Purposive sampling method was used in the study and semi-structured interviews were conducted with 12 mothers. All interviews were audio recorded and transcribed. Inductive thematic analysis method was used. The study was written based on the COREQ checklist. FINDINGS: Three themes, eight sub-themes, and 19 categories were identified: The effects of the disease on the physical health of the child and mother in the biological effects theme; psychosocial responses to disease, adaptation to treatment, future anxiety, coping strategies, and communication/interaction in the psychosocial effects theme; search for purpose-meaning in life and understanding belief/basic human values in the spiritual effects theme. DISCUSSION: It has been concluded that food allergies affect maternal health extensively, especially in the psychosocial field, and that it affects family relationships, the time that mothers spare for themselves, and physical and spiritual health. APPLICATION TO PRACTICE: The findings will be a guide for improving the quality of life of mothers followed up with food allergies and for the care and counseling support to be provided to mothers.

Quality of life in children with food allergies, psychiatric symptoms, and caregiving burden of their mothers

Objective: The present study aimed to evaluate the quality of life in children with food allergies, the accompanying depression and anxiety disorders, and caregiving burden of their mothers. Material and Methods: A total of 168 children with food allergy visiting our clinic and their mothers were included in the study group. The control group included 152 children who visited the healthy child follow-up clinic of our hospital and their mothers. Studying mothers’ opinions, the Food Allergy Quality of Life Questionnaire Parent Form (FAQLQ-PF) was used for evaluating children, and the Beck’s Depression Inventory, Beck’s Anxiety Inventory, Temperament Evaluation of Memphis, Pisa, Paris, San Diego Auto-questionnaire, and Zarit Caregiver Burden Scales were used for evaluating mothers. Results: No differences were noticed between the study and control group regarding mean age and gender distribution (P > 0.05). In the study, the FAQLQ-PF total and subscale scores of children with food allergies were determined according to the opinions of their mothers, and scores tended to increase with age (P < 0.0001). In addition, it was determined that mothers of children with food allergies had higher levels of anxiety, depression, and caregiving burden than mothers of the control group (P < 0.0001). Conclusion: In order to develop a multidisciplinary approach for children with food allergies, we conceived as appropriate to inform their families about the difficulties of caregiving and psychosocial disorders that could develop over time. They also must be informed to take preventive measures as well as the medical aspects of their children’s disease (AU)

Managing food allergies at school: A qualitative study.

INTRODUCTION: The prevalence of childhood allergic diseases, including food allergies, has increased globally. Parents and children have experienced psychosocial and financial difficulties, decreased quality of life, anxiety, and depression in the management of food allergies in schools. PURPOSE: The aim of the study was to determine the challenges experienced by mothers of children with food allergies during their children's school life. DESIGN: A qualitative phenomenological study design was used. METHODS: Online interviews were conducted with 9 mothers who have children with food allergies between June-August 2022. The data were analyzed using the content analysis method. The COREQ checklist was used in the study. RESULTS: The ages of the mothers participating in the study ranged from 28 to 40. Four themes were generated from 75 codes: 1) Problems experienced in the process of utilizing health services, 2) Burden of care, 3) Coming out of the shell: The school process, and 4) Environmental and social perspective. CONCLUSIONS: Mothers carried the burden of food allergy management during the school process, and the increased burden of care negatively impacted mothers emotionally, physically, and socially. Also, mothers were anxious about the safety of their school-age children with food allergies and their experiences with school administration, teachers, and other parents made it difficult for food allergy management in the school environment. CLINICAL RELEVANCE: Children with chronic health problems such as food allergies need to be closely monitored by a health professional in school to ensure their safety. Nurses have a pivotal role in supporting families to address their child's food allergies competently, hence fostering positive health outcomes. This study showed that there was a need for the development of school health policies to ensure the safety of children with food allergies and to reduce anxiety and care burden among mothers.

Food allergy in adolescents: validation of the food allergy independent measure and the EuroPrevall food allergy quality of life questionnaire into Spanish

Background: Different questionnaires have been developed globally to assess and compare the impact of food allergy on the quality of life. The aim of this study was to validate a Spanish translation of the Food Allergy Independent Measure (FAIM) and the EuroPrevall Food Allergy–Quality of Life Questionnaire–Teenage Form (FAQLQ-TF) for adolescents aged 13–17 years. Methods: Sixty adolescents diagnosed with immunoglobulin E-mediated allergy to food completed the questionnaires. Cronbach’s alpha was used to assess internal consistency; correlation between FAQLQ-TF and FAIM was used to test construct validity. The discriminant validity was evaluated by comparison with the number of offending foods, the perceived impact on social life, the diagnosis of anaphylaxis, and the previous prescription of adrenaline auto--injectors (AAI). Results: No question fulfilled criteria to be removed from the questionnaire. For FAIM, Cronbach’s alpha = 0.763, and for the four domains of FAQLQ-TF, Cronbach’s alpha = 0.797–0.847. A significant correlation existed between FAQLQ-TF and FAIM, and of both of them with anaphylaxis and the prescription of AAI (P ˂ 0.05 for all comparisons). Conclusions: This Spanish translation of FAIM and FAQLQ-TF for adolescents had good internal consistency and construct validity as well as ability to discriminate patients according to the number of foods to avoid, impact on social life, diagnosis of anaphylaxis, and AAI prescription (AU)

Validation and Reliability of the Thai version of the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF).

BACKGROUND: Food allergy has an impact on the quality of life of both patients and caregivers. It is, therefore, important to have a native language survey to evaluate health-related quality of life (HRQL) among food allergic children. OBJECTIVE: To translate the Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) to Thai language, and to validate this tool in Thai parents with food allergic children. METHODS: The FAQLQ-PF was translated into Thai language according to WHO guideline. The FAQLQ-PF Thai version was then administered to the parents of food allergic Thai children aged 0-12 years. The FAQLQ-PF Thai version was then readministered to those same parents 10-14 days after they first completed this assessment tool. Internal consistency by Cronbach's α and test-retest reliability by intraclass correlation coefficient (ICC) were assessed. The discriminant validity of the questionnaire was also evaluated. RESULTS: Ninety parents of participants answered the FAQLQ-PF Thai version. Of those, 9 parents (10%) incompletely answered the first questionnaire. The FAQLQ-PF Thai version showed good internal consistency (Cronbach's α ≥ 0.799), but the test-retest reliability was only fair (ICC > 0.6). Factors that adversely affected the quality of life of Thai children with food allergy included age, presence of anaphylaxis, frequency of reactions, and the number of implicated foods. Patients with wheat allergy were negatively impacted in all domains of quality of life, whereas those with shellfish allergy had only emotional impact. CONCLUSIONS: The FAQLQ-PF Thai version is a reliable and valid tool for assessing HRQL in Thai children with food allergy.

Genetic Variation, Stress, and Physiological Stress Response in Adults With Food Allergy or Celiac Disease.

BACKGROUND: Persistently high chronic stress can lead to maladaptive psychological, behavioral, and physiological stress responses and poor mental and physical health, highlighting the importance of identifying individuals at increased risk. Chronic health condition diagnosis and genetics are 2 characteristics that can influence stress, stress response, and health outcomes. PURPOSE: Food allergy (FA) and celiac disease (CD) require constant vigilance in daily life and can lead to increased stress. The purpose of this exploratory analysis was to examine the association of variants in selected stress-related genes with stress exposures, stress, clinical measures of physiological stress response, and mental health symptoms in adults with and without FA or CD. METHODS: We compared stress exposures, symptoms of PTSD, depression, anxiety, and stress, BMI, and waist-hip ratio between cases and controls. We analyzed the association of SNPs in genes with known or hypothesized associations with stress-related measures in 124 cases and 124 matched controls: CRHBP (rs7718461, rs10474485), CRHR1 (rs242940) and OXTR (rs2268490). For this exploratory study, p-values ≤ 0.10 were considered suggestive. RESULTS: For cases and controls, rs7718461 was associated with stress symptoms, rs2268490 with symptoms of stress and PTSD, and rs242940 with symptoms of stress, PTSD, anxiety, and depression. Further analyses found that stress-related outcomes in individuals with FA or CD may be influenced by SNP genotype. CONCLUSIONS: Given these suggestive findings, larger prospective studies should examine similar relationships in individuals with other chronic health conditions, incorporating factors such as environmental exposures, individual experiences, and epigenetic modifications.

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.

Self-Reported Anxiety Ratings in Children With and Without Food Allergies and Teacher Knowledge of Food Allergies.

BACKGROUND: Researchers have found a relationship between having food allergies and anxiety in children. Anxiety may relate to others' lack of food allergy knowledge. This study investigated the relationship between having a food allergy and self-reported anxiety among children. Furthermore, knowledge of food allergies among children without food allergies and teachers was explored. METHODS: Children with food allergies and their parents each completed a perceived food allergy severity questionnaire. Children without food allergies completed a food allergy knowledge measure. All children completed a self-reported anxiety measure. Teachers completed a questionnaire investigating knowledge, attitudes, and beliefs about food allergies. Correlational analyses and analyses of variance were conducted. RESULTS: Overall anxiety was significantly higher in children with food allergies than in children without food allergies. When controlling for the effects of sex and age, children with food allergies had significantly higher social phobia and school phobia. Teachers correctly answered 69.7% of knowledge-based questions about food allergies; children without food allergies correctly answered 62.7%. CONCLUSIONS: Findings highlight the need for an integrated approach in which families, school personnel, psychologists and other mental health professionals, and medical professionals work together to increase awareness about the multifaceted needs of children with food allergies.

The burden of food allergy on children and teens: A systematic review.

BACKGROUND: Over the last two decades, researchers have placed increasing attention on understanding how food allergy affects the health-related quality of life (HRQL) and psychosocial well-being of children and teens. In response, a number of reviews have been published that aim at synthesizing the literature. However, many of these papers focus narrowly on HRQL or suffer from methodological limitations. METHOD: The current review aims to fill this gap by providing a comprehensive overview of the burden of pediatric food allergy by synthesizing the quantitative and qualitative literature. RESULTS: Findings from the present review provide evidence of reduced HRQL among children and teens with food allergy, particularly older children and those with more severe manifestations of the condition. In comparison to HRQL, the link between food allergy and psychosocial functioning is less clear; however, some evidence can be cited linking food allergy to greater levels of psychological distress. Qualitative evidence suggests that the burden of pediatric food allergy largely stems from worries surrounding exposures outside of the home and the social consequences of the condition. The current review also highlights several gaps in the literature, including a paucity of longitudinal research, research focused on predictors of psychological distress among children and teens with food allergy as well as a dearth of studies comparing rates of bullying in food-allergic and non-food-allergic samples. CONCLUSION: More emphasis should be placed on not only alleviating the social and psychological consequences of food allergy, but also on identifying and assisting those most acutely burdened by the condition.

Psychometric Properties of a Measure Assessing Anxiogenic Parenting Practices in Food Allergy.

AIM: Pediatric food allergy represents a significant public health burden. In order to avoid allergen consumption, adequate management requires daily vigilance and involvement from parents, frequently leading to increased parental anxiety. While specific anxiogenic parenting practices (i.e., parenting behaviors which may aid in the development and/or exacerbation of childhood anxiety) have been documented within this population, to this point, these behaviors have not been systematically measured. OBJECTIVES: The current study aimed to develop and examine a parent-report scale designed to measure anxiogenic parenting behaviors related to food allergy. METHODS: Participants included 177 parents of children with food allergy recruited online using Amazon Mechanical Turk (mTurk). An exploratory factor analysis was conducted to determine the factor structure of the newly developed scale. Subsequently, psychometric properties (e.g., construct validity) were examined via correlational analyses. RESULTS: Results indicated a 24-item, 3 factor (Factor 1: Involvement in Food Allergy; Factor 2: Worry about Food Allergy; Factor 3: Autonomy Promotion) scale, which accounted for 53.11% of the total variance. The Kaiser-Meyer-Olkin measure was acceptable, KMO = 0.872 and Bartlett's test of sphericity indicated sufficient correlations between items (χ2(378)=2568.95). All subscales demonstrated strong internal consistency (Involvement in Food Allergy: α = .880; Worry about Food Allergy: α = .892; Autonomy Promotion α = .796) as well as convergent and discriminant validity. CONCLUSIONS: Results support the overall psychometric properties of the scale. Interpretations, limitations, and future directions are discussed.

Development of IMPAACT (Impairment Measure for Parental Food Allergy-Associated Anxiety and Coping Tool), a validated tool to screen for food allergy-associated parental anxiety.

BACKGROUND: Parents commonly experience anxiety owing to their children's food allergies (FAs). Although FA-specific anxiety screening tools for adult and pediatric patients exist, a tool for parents with children with food allergy is lacking. OBJECTIVE: To develop and validate a tool that measures parental anxiety related to their child's FA. METHODS: To construct the instrument, items were developed based on consultations with stakeholders and review of existing literature. The instrument was then pilot tested, and items were modified based on relevance, importance, item-total correlations, and fit with the instrument's overall factor structure. The modified instrument was validated through assessing internal validity (reliability), convergent and discriminant validity, concurrent validity, and practical usefulness at 2 time points (precoronavirus disease 2019 and current). RESULTS: The scale showed excellent reliability (Cronbach's α = 0.95). It had a 4-factor structure that was replicated at the 2 time points. The 4 subscales were moderately correlated (between r = 0.438 and 0.744). The scale showed excellent convergent and discriminatory validity, correlating moderately with State Trait Anxiety Inventory and Generalized Anxiety Disorder, and highly with Food Allergy Quality of Life-Parental Burden. It also showed excellent concurrent validity, differentiating among many external variables. Most importantly, it successfully differentiated parents in need of psychological support for problems related to their child's FA. CONCLUSION: The Impairment Measure for Parental Food Allergy-associated Anxiety and Coping Tool fills a gap in the existing literature as a validated screening tool for parental anxiety associated with a child's FA, employing a multi-factor structure addressing multiple dimensions of anxiety and its functional impacts. It has excellent internal and external validity and is well-suited for use in both research and clinical settings to quickly determine which parents of children with FA are in need of further psychological support.

Self-Efficacy Among Caregivers of Children With Food Allergy: A Cohort Study.

OBJECTIVE: The prevalence of pediatric food allergy (FA) is increasing and, due to early disease onset, requires significant caregiver management that is associated with psychosocial burden. Caregiver perception of how they cope and handle FA-related events (self-efficacy) has been linked to psychosocial outcomes in racially/geographically homogenous samples. This study explores FA-related caregiver self-efficacy and associations with FA-related caregiver quality of life (QoL) in a diverse cohort. METHODS: Caregivers of children, diagnosed with IgE-mediated FA who identified as non-Hispanic Black or White, were recruited from U.S. academic allergy clinics. Caregivers completed demographic and medical questionnaires, the Food Allergy Self-Efficacy Scale for Parents (FASE-P), Food Allergy Independent Measure-Parent Form (FAIM), and the Food Allergy Quality of Life-Parental Burden (FAQL-PB). Bivariate and multivariate associations estimated relationships between study variables. RESULTS: Caregivers of 365 children (Mage = 5.8 years, 62.2% male, 31.1% Black) were enrolled. Caregivers reported high FA self-efficacy (M = 82.06/100), moderate perceptions of risk/FA severity (FAIM: M = 3.9/7), and some limitations on the FAQL-PB (M = 3.9/7). Self-efficacy was related to lower perceptions of risk/FA severity across all demographic groups (r = -.42, p < .001). Caregivers who reported higher self-efficacy reported better QoL, particularly Black caregivers (r = .67). CONCLUSIONS: In this sample of caregivers of children with FA, greater self-efficacy was related to improved QoL regardless of sociodemographic factors. Caregivers' perception of risk was lower for those with greater self-efficacy. Future research into the impact of FA management on QoL among diverse caregivers is needed.

Validation of the food allergy independent measure and the EuroPrevall food allergy quality of life questionnaire for children 8–12 years translated into Spanish

Background Different questionnaires have been developed to measure quality of life (QoL) in patients with food allergy. Our aim was to validate a Spanish translation of the Food Allergy Independent Measure (FAIM) and the EuroPrevall Food Allergy Quality of Life Questionnaire—Child Form (FAQLQ-CF) for children aged 8–12 years.Methods Sixty children with a diagnosis of IgE-mediated allergy to food completed the questionnaires. The internal consistency was evaluated with Cronbach’s alpha. The correlation of FAQLQ-CF with FAIM was assessed to test construct validity. We compared both values with the diagnosis of anaphylaxis to evaluate discriminant validity.Results Cronbach’s alpha was in the range of 0.654–0.863 for the four domains of FAQLQ-CF and 0.779 for FAIM. There were no criteria to remove questions from the questionnaires. Significant correlations could be found between FAQLQ-CF and the number of offending foods and the impact on social life (all r > 0.33, P < 0.01), and between FAIM and anaphylaxis.Conclusions The Spanish translation of FAQLQ-CF showed acceptable internal consistency, good construct validity, and capacity to discriminate patients depending on the number of foods to avoid and the impact on social life. FAIM showed good discriminant capacity for anaphylaxis (AU).

Maternal anxiety and previous anaphylaxis are associated with alexithymia in young patients with food allergy.

BACKGROUND: Alexithymia is a multifaceted personality construct described as "a lack of words to express emotions" that includes difficulty identifying feelings, difficulty describing feelings and a concrete, externally oriented cognitive style. Among patients with food allergy (FA) alexithymia has been found higher than in general population and associated with dysfunctional coping strategies. Childhood traumatic experiences and/or dysfunctional parent-child relationship can contribute to alexithymia. The study aimed to explore possible associations between child alexithymia and mother alexithymia and anxiety, as well as previous anaphylaxis. METHODS: Sixty-five mother-child pairs have been recruited. Children had a medical diagnosis of FA. The Toronto Alexithymia Scale-20 was used to assess alexithymia in participants. The State-Trait Anxiety Inventory was used to assess trait anxiety in mothers. Statistical analysis was performed to investigate the influence of variables sex, previous anaphylaxis, and adrenaline auto-injector prescription on child and mother's alexithymia and to explore possible association between maternal and child alexithymia. RESULTS: A substantial percentage of children were alexithymic (21.5%) or borderline (33.8%), while mothers' frequencies were lower and in line with prevalence in general population. Child alexithymia was positively associated with previous anaphylaxis and mothers' trait anxiety (p < .05). Mother trait anxiety was also associated with maternal alexithymia. Furthermore, a positive association between child and mother alexithymia has been found. CONCLUSIONS: Clinicians must be aware of the role of alexithymia and its association with maternal anxiety and previous anaphylaxis in children with FA, encouraging seeking psychological support when needed. A multidisciplinary patient-centered approach should be put in place for the effective care of FA.

Living with Food Hypersensitivity as an Adolescent Impairs Health Related Quality of Life Irrespective of Disease Severity: Results from a Population-Based Birth Cohort.

Food hypersensitivity (FHS) refers to food-related symptoms, with or without concurrent Immunoglobulin E (IgE) antibodies related to food(s). It remains unclear how different FHS phenotypes affect health-related quality of life (HRQoL). We examined self-reported HRQoL (with the generic instrument EQ-5D (dimensions and a Visual Analogue Scale (VAS), range 0-100) in association with phenotypes of FHS, and food-specific symptoms among adolescents (n = 2990) from a population-based birth cohort. Overall, 22% of the adolescents had FHS. Compared to adolescents without FHS, those with FHS reported more problems in the dimensions of pain/discomfort (p < 0.001), and anxiety/depression (p = 0.007). Females with FHS reported more problems than males in these dimensions (p < 0.001). Different FHS phenotypes (IgE-sensitization, allergic co-morbidity, and severity of symptoms) were not associated with differences in HRQoL. EQ-VAS scores were lowest for adolescents with symptoms for wheat vs. no wheat, median 80 vs. 89, p = 0.04) and milk vs. no milk (median 85 vs. 90, p = 0.03). Physician-diagnosed lactose intolerance median EQ-VAS was 80 vs. 90, p = 0.03 and also associated with more problems in the dimension of anxious/depression. In conclusion, FHS is associated with lower HRQoL in adolescence, irrespective of phenotypes, but differentially affects females vs. males, and those with vs. without symptoms for milk or wheat.