Beyond Avoidance: the Psychosocial Impact of Food Allergies

Feng, Charles; Kim, Jea-Hyoun

doi:10.1007/s12016-018-8708-x

Cited by 101 publications

(92 citation statements)

References 51 publications

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“…[1][2][3][4][5][6] The traditional approach in food-allergic patients, consisting of an elimination diet, is hampered by adverse reactions due to accidental exposures and is associated with significantly impaired quality of life (QOL). [7][8][9][10][11] Oral immunotherapy (OIT) has been shown to be an effective alternative treatment for patients with food allergy [12][13][14][15][16][17][18][19][20][21][22][23] and was recently recommended as a treatment option by the European Academy for Allergy and Clinical Immunology. 20 However, the treatment itself imposes many difficulties.…”

Section: Introductionmentioning

confidence: 99%

Quality of life of children aged 8‐12 years undergoing food allergy oral immunotherapy: Child and parent perspective

Epstein‐Rigbi

Goldberg

Levy

et al. 2020

Allergy

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Background: Oral immunotherapy (OIT) for food allergy improves the quality of life (QOL) of children from parental perspective but little is known about the child perception. Methods: The Food Allergy Quality of Life Questionnaire-Child Form (FAQLQ-CF) was administered to children aged 8-12 years, and the FAQLQ-Parent Form (FAQLQ-PF) was administered to their parents at the start of OIT for milk, egg, peanut, sesame, or tree nuts, at the end of up-dosing, and after 6 months of follow-up. Food-allergic children not undergoing OIT served as controls. Children QOL scores were compared to their parents. Results: The total FAQLQ-CF score of 103 children undergoing OIT improved significantly from start of OIT (median (IQR); 4.8, 3.8-5.7) to end of up-dosing (3.9, 3-5.2) (P < .001). A greater improvement was noted in the 56 children who reached a followup visit, from 5.0 (3.7-5.8) at OIT start to 3.1 (1.8-5.0) on follow-up, (P < .001). In contrast, FAQLQ-CF scores of control patients improved mildly and nonsignificantly between the two time points from 5.3 (4.3-5.7) to 4.8 (3.6-6.0), (P = .13). The improvement in the total FAQLQ-CF scores from OIT start to follow-up was significantly greater compared to the change in control patients during observation (P = .015). Parents reported better QOL scores compared to their children at all stages of OIT (start 4.0, 3.2-5, P = .004; end of up-dosing 2.9, 1.9-4.7, P = .04; follow-up 2.2, 1.6-3.6, P = .003). Conclusions: QOL of food-allergic children undergoing OIT improves significantly compared to controls. Parents perceive QOL to be better than the perception of the children.

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Section: Introductionmentioning

confidence: 99%

Quality of life of children aged 8‐12 years undergoing food allergy oral immunotherapy: Child and parent perspective

Epstein‐Rigbi

Goldberg

Levy

et al. 2020

Allergy

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“…In addition to the physical consequences of an allergic reaction, a multitude of adverse psychosocial aspects of living with FA exist, such as anxiety, social isolation, and related bullying. 10,11 The approval by the US Food and Drug Administration (FDA) of Palforzia in January 2020, the first drug approved for FA in the form of peanut oral immunotherapy (OIT), 12 is a first step towards safe and effective treatments for FA. Palforzia is a highly characterized and standardized peanut OIT formulation.…”

Section: Introductionmentioning

confidence: 99%

Oral immunotherapy for peanut allergy: The pro argument

Chinthrajah

Cao

Dunham

et al. 2020

World Allergy Organization Journal

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Food allergy (FA) is a growing public health problem with personal, social, nutritional, and economic consequences. In the United States, it is estimated that 8% of children and 10.8% of adults have food allergies. Allergies to peanuts are particularly worrisome as unlike allergies to other allergenic foods, such as milk and egg, which are commonly outgrown by 5 or 10 years of age, 80% of peanut allergies persist into adulthood. The first drug for peanut allergy, Palforzia, was approved by the US Food and Drug Administration (FDA) in January 2020. For other food allergies, the current standard of care for the management of FA is suboptimal and is limited to dietary elimination of the offending allergen, vigilance against accidental ingestion, and treatment of allergic reactions with antihistamines and epinephrine. However, dietary avoidance can be challenging, and it is estimated that approximately 40% of patients with food allergies report at least one food allergy-related emergency department in their lifetime. Reactions, even from minimal exposures, can be life-threatening. Oral immunotherapy (OIT) has been the best researched therapeutic approach for treating FA over the last decade, with clinical trials investigating its efficacy, safety, and ability to improve participants' quality of life (QoL). A number of studies and meta-analyses have shown that OIT treatment is effective in raising the threshold of reactivity to peanuts and other foods in addition to producing a measurable serum immune response to such therapy. Although OIT-related adverse events (AEs) are common during treatment, serious reactions are rare. In fact, while the majority of patients experience AEs related to dosing, most continue daily dosing in hopes of achieving protection against the culprit food. Moreover, the majority of participants report improvement of QoL after OIT and are positive about undergoing OIT. These results show patients' commitment to OIT and their optimism regarding the benefits of treatment. As a first step in therapeutic options to protect from reactions to unintentional ingestion of allergenic foods, and importantly, to address the many psychosocial aspects of living with FA, OIT shows promise. Future research will focus on identifying optimal OIT regimens that maintain protection after therapy and allow for regular food consumption without allergic symptoms. Education and informed shared decision making between patients and providers are essential in optimizing current therapy regimens.

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“…18.0% of parents in this study reported high FAAA. Although there was no control group in this study, others have found higher anxiety in parents of food‐allergic children compared with controls 16 . Compared with mean STAI‐S scores from studies of mothers of patients enrolled from paediatric allergy clinics, the mean STAI‐S score for parents in this study (42.0) was higher than that reported in three studies in the United Kingdom (34.6, 36.2, 38.0), 7,17,18 and similar to a Turkish study (41.5) 19 .…”

Section: Discussionmentioning

confidence: 74%

“…In addition, sensitivity and specificity analysis, and factor analysis, from this study points to a common theme that current available measures (eg STAI, FAQL‐PB), while frequently used in food allergy research, do not adequately identify parents who are highly anxious about their child's food allergy. Given that excessive anxiety in parents of children with chronic disease can have negative consequences on the parent and the child, 16 it is important to develop a validated FAAA screening tool for use outside of research that can be completed quickly by parents and interpreted easily by allergists. Building upon these results, future research by the authors of this study will include development of a validated FAAA screening tool for the clinical setting, to identify parents with high FAAA so that psychosocial supports and resources (which are limited in many settings) can be targeted towards those who most need them.…”

Section: Discussionmentioning

confidence: 99%

Current tools measuring anxiety in parents of food‐allergic children are inadequate

Soller

Hsu

et al. 2020

Pediatric Allergy Immunology

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Background In the context of food allergy, excessive parental anxiety can be maladaptive and lead to unnecessary restriction of social activities. No validated tool exists to measure food allergy–associated anxiety (FAAA). This study sought to explore factors associated with parental FAAA, determine sensitivity and specificity of using generic state anxiety measure—State‐Trait Anxiety Inventory (STAI) versus FAAA, and determine whether validated tools for generalized anxiety or food allergy–specific quality of life (QoL) could be used as surrogates for FAAA. Methods Canadian parents of food‐allergic children completed an online survey. Without a validated tool for FAAA, a visual analogue scale was used to assess parent‐reported FAAA. Multivariable linear regression was performed with FAAA as the outcome. Sensitivity and specificity analysis of state anxiety vs. FAAA, and factor analysis of state anxiety and QOL, was performed to determine whether these could be used as surrogates for FAAA. Results A total of 548 of 1244 parents (44.1%) completed the survey. Factors positively associated with FAAA included parental burden, risk perception, state anxiety, intolerance of uncertainty and perceived severity of child's food allergy; personal/family history of mental health was negatively associated. Sensitivity and specificity of state anxiety were 68.6% and 70.0%. Factor analysis revealed that state anxiety and QOL were correlated (r = 0.54, P < .001) but distinct constructs. Conclusion Our study identified factors associated with FAAA, and determined that generic anxiety and QOL tools do not accurately categorize parents with self‐reported high FAAA. Future research will develop a validated screening tool to help allergists identify anxious parents and provide psychosocial resources.

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Beyond Avoidance: the Psychosocial Impact of Food Allergies

Cited by 101 publications

References 51 publications

Quality of life of children aged 8‐12 years undergoing food allergy oral immunotherapy: Child and parent perspective

Quality of life of children aged 8‐12 years undergoing food allergy oral immunotherapy: Child and parent perspective

Oral immunotherapy for peanut allergy: The pro argument

Current tools measuring anxiety in parents of food‐allergic children are inadequate

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