Parent and child perception of quality of life in a randomized controlled peanut oral immunotherapy trial

Abstract

Background Improved quality of life (QoL) after oral immunotherapy (OIT) in peanut allergic children is often reported by their parents, while the child's perspective is less clear. Objective We aimed to explore whether 2 years of OIT improved QoL in children with peanut allergy and to identify factors influencing change in QoL. Methods In the open‐labeled TAKE‐AWAY peanut OIT trial including children with anaphylaxis to peanuts, 57 were randomized to OIT and 20 to observation. The Pediatric Quality of Life Inventory Version 4.0 was completed by parents and children at enrollment (Y0), after 1 year (end of updosing; Y1) and after 2 years (Y2) of OIT. Minimally clinically important difference (MCID) is ≥5.3. Perceived treatment burden was recorded by visual analogue scales, including adverse events (AEs). An open food challenge (OFC) was performed at Y2. Results At Y2, 18 children had discontinued OIT and 2 of 39 OIT children refused OFC, while 35 of 37 were desensitized to 7500 mg peanut protein. From Y0 to Y2, the mean change (95% confidence intervals) in QoL was 4.4 (0.5, 8.3) among child self‐reports and twice as large among parental proxy reports (9.3 [4.3, 14.3]; both P < 0.0001), without significant improvement among the controls. The change in QoL was significantly different from the controls for the parental proxy reports only (P = 0.002). Neither treatment burden nor AEs significantly predicted changes in QoL. Conclusion Two years of OIT improved child‐QoL as reported by parents, but not by the children, suggesting that parents may overestimate improvement in child‐QoL by OIT.

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

“…[29][30][31][32][33][34][35] However, data on QOL of children undergoing OIT, from the child perspective, is limited to small or uncontrolled studies. [38][39][40] In the largest group of children studied thus far, we found a significant improvement, both statistically and clinically, in QOL from start to the end of up-dosing of OIT. This improvement was exhibited for all domains, and was not related to the clinical history nor the course of OIT.…”

Oral immunotherapy for peanut allergy: The pro argument

“…In a randomized controlled study performed by Reier-Nilsen et al 34 children and parents were administered the PedsQL 4.0 and FAQL-PB at enrollment, end of up-dosing, and after 2 years. This study reported a significant improvement of the PedsQL scores among children in the OIT group but not in the control group.…”

“…No changes on QoL scores in the control group at 18-month follow-up. Reier-Nilsen, 2019 34 Randomized controlled trial (Norway 37 children 5–15 years old Peanut OIT PedsQL 4.0 FAQLQ-PB HRQL scores pre- and post-OIT Yes Significant improvement in children and parents after up-dosing and maintenance phases in both OIT and control groups. The change in QoL was significantly different from the controls for the parental proxy-reports only …”

Peanut Oral Immunotherapy: a Current Perspective

“…In a follow-up study 4 years after treatment was stopped, participants from the PPOIT group were more likely than those from the placebo group to have continued eating peanut (67% vs 4%). Fifty-eight percent of participants from the PPOIT had SU at 8 weeks compared to 17% in the placebo group [19]. These results continue to show the effectiveness in peanut OIT; however, additional studies with these specific therapies (i.e., sealed peanut capsule and adjunctive probiotic use) would need to be replicated in order to assess the role it played in achieving the primary endpoints in comparison to other larger peanut OIT clinical trials.…”