To cite this article: Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy 2010; 65: 933-945.Food allergy is an increasing problem in adults and children. The incidence has increased dramatically in recent years, with a possible doubling in the incidence of peanut allergy over 4 years (1). The severity of allergic disease also appears to be increasing as demonstrated by doubling of hospitalization for anaphylaxis over a 5-year period (2). A number of severe, life-threatening allergies that were once rare are now increasingly common, such as kiwifruit allergy in young children (3).There is no cure or preventative treatment for food allergy at present. Therefore, management is restricted to avoidance of the implicated food via elimination diets and emergency treatment of symptoms caused by accidental ingestion, with the aid of treatment plans, which aim to reduce morbidity, mortality and improve quality of life (QoL). Morbidity is low and mortality exceedingly rare in those suffering from food allergy (4). However, the impact of food allergy on aspects of daily living and QoL, as well as emotional states such as anxiety and depression, has been shown to impact adversely on the child and family. These studies have varied in their sample characteristics, in the age of participants investigated and in the instruments used, which have included a mixture of nonvalidated and validated generic health and food allergy-specific scales (Table 1). This review examines what is currently known about the psychosocial impact of food allergy and hypersensitivity on children and their families and explores the implications of this for health and management of food hypersensitivity, whilst highlighting further avenues of research.The following databases were searched for studies published in English from 1990 to 2009: PubMed, Medline, PsycInfo, Cinahl and Web of Science. The following search terms were used: food allergy, food hypersensitivity, food intolerance, adverse food reaction, exclusion diet, elimination diet, quality of life, well-being, daily activities, psychological distress, anxiety, depression, allergic reactions, anaphylactic reactions and gender. Articles were examined by all authors of this review for relevance. The term food hypersensitivity in this review is used to refer to allergic and nonallergic hypersensitivity and food intolerance. Food allergy is only used to AbstractFood allergy affects 6% of children but there is no cure, and strict avoidance of index allergens along with immediate access to rescue medication is the current best management. With specialist care, morbidity from food allergy in children is generally low, and mortality is very rare. However, there is strong evidence that food allergy and food hypersensitivity has an impact on psychological distress and on the quality of life (QoL) of children and adolescents, as well as their families. Until recently, the measurement of QoL...

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Severe asthma imposes a significant burden on patients, families and healthcare systems. Management is difficult, due to disease heterogeneity, co-morbidities, complexity in care pathways and differences between national or regional healthcare systems. Better understanding of the mechanisms has enabled a stratified approach to the management of severe asthma, supporting the use of targeted treatments with biologicals. However, there are still many issues that require further clarification. These include selection of a certain biological (as they all target overlapping disease phenotypes), the definition of response, strategies to enhance the responder rate, the duration of treatment and its regimen (in the clinic or home-based) and its costeffectiveness. The EAACI Guidelines on the use of biologicals in severe asthma follow the GRADE approach in formulating recommendations for each biological and each outcome. In addition, a management algorithm for the use of biologicals in the clinic is proposed, together with future approaches and research priorities.

It is well-established that food proteins, such as egg, soya, cow's milk and wheat, are detectable in breastmilk for many hours or days after ingestion. Exposure to these proteins is important to the process of developing tolerance but can also sometimes elicit IgE-mediated and non-IgE-mediated allergic symptoms in breastfed infants. Non-IgEmediated allergy, outside of food protein-induced allergic proctocolitis and eosinophilic oesophagitis, is not well understood, leading to variations in the diagnosis and management thereof. A primary objective of the European Academy for Allergy and Clinical Immunology is to support breastfeeding in all infants, including those with food allergies. A Task Force was established, to explore the clinical spectrum of non-IgE-mediated allergies, and part of its objectives was to establish diagnosis and management of non-IgE-mediated allergies in breastfed infants. Eight questions were formulated using the Patient, Intervention, Comparison, Outcome (PICO) system and Scottish Intercollegiate | 15 MEYER Et al. Highlights MEYER Et al. consultancy in the past for AbbVie. CV gives academic lectures for Mead Johnson, Abbot, Danone/Nutricia and Nestle; and received research support from Thermo Fisher. AUTH O R CO NTR I B UTI O N S RM involved in the literature review, writing of sections in article, Delphi consensus, merging of article sections and final submission. ACL involved in the literature review, writing of sections in article, Delphi consensus and critical review of publication. CD, RK, ANW, GdT, DF, YV, MCV, OC, PU and NS involved in writing of sections in article, Delphi consensus and critical review of publication. CV involved in the literature review, writing of sections in article, Delphi consensus and critical review of publication.

Nut allergy is known to impact on the quality of life (QoL) and anxiety of both the allergic child and their parents, but little is known about how the management of food allergy is associated with these variables. To investigate the impact of nut allergy on QoL and anxiety in mothers and children with nut allergy in order to identify management strategies that may influence these factors. Forty-one nut allergic children (age 6-16 yrs) and their mothers completed questionnaires to assess maternal and children's QoL (PedsQL, WHOQOL-BREF, FAQL-PB), anxiety (SCAS, STAI) and perceived stress scale (PSS). Children also completed a nut allergy specific QoL questionnaire. Demographic data, details of previous reactions, test results and management plans were collected using parent-report questionnaires and hospital notes. Children with nut allergy had poorer emotional (p = 0.004), social (p = 0.043), and psychological (p = 0.006) QoL compared to healthy normative data. Maternal and child QoL and anxiety were not influenced by the severity of previous reactions. Mother and child reported lower anxiety (p = 0.043 and p < 0.001 respectively) when the child was prescribed an epinephrine auto-injector. Anxiety was not associated with whether the child carried the auto-injector or whether they strictly avoided traces of nuts in foods. Prescribing auto-injectors is associated with reduced anxiety for food allergic children and their mothers, but is not associated with improved adherence with medical management or reduced risk-taking behavior.