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

Abstract

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.

Cow’s Milk Protein Allergy as a Model of Food Allergies

“…The risk–benefit ratio of OIT is still debated. While the efficacy of this approach has been well studied, the evaluation of an effective improvement in the QoL of the patient remains limited to small or uncontrolled studies [ 139 ]. In fact, only few studies evaluate children’s perceptions of improved of their QoL as compared to perceptions by parents.…”

“…In fact, only few studies evaluate children’s perceptions of improved of their QoL as compared to perceptions by parents. A recent paper [ 139 ] described how OIT could improve the QoL of (both partially and totally desensitized) food-allergic children and their parents, through the Food Allergy Quality of Life Questionnaire—Child Form (FAQLQ-CF) and the FAQLQ—Parent Form (FAQLQ-PF), respectively. These results were concordant with those of Carraro et al, who gave the same questionnaire to parents of patients with CMA and found a substantial increase in all the investigated areas of QoL (emotional impact, food anxiety, and social and dietary limitations) in children with CMA [ 140 ].…”

Integrating oral immunotherapy into clinical practice

“…Three studies that used the validated Food Allergy Quality of Life Questionnaire and included controls reported improvement in scores pre-and postactive OIT in children and/or their parents. 11,24,25 Further study into the effect of OIT on QOL will facilitate the discussion of long-term benefits of this treatment.…”

“…13 Proactively protecting children from accidental ingestions that are mostly inevitable can be life-changing, and it is evident to providers of OIT that most patients on such therapies and their families experience gratitude and relief. 11,25 Patient advocacy groups, such as Food Allergy Research and Education, invested start-up funds into new companies that would be able to translate emerging data from small clinical trials done at academic centers into phase II and III clinical studies that could lead to an FDA-approved product for clinical use. On its website, Aimmune Therapeutics credits its formation ''to a united call to action by leading stakeholders in food allergy.''…”

“…3 Oral immunotherapy (OIT) trials have primarily focused on peanut, cow's milk, and egg; however, wheat, tree nuts, and sesame OIT trials have been conducted, as well as multiallergen OIT. 2,[4][5][6][7][8][9][10][11] Only in 2020 was the first food allergy treatment, a peanut OIT drug called Palforzia (Aimmune Therapeutics, Brisbane, Calif), approved by the Food and Drug Administration (FDA). A peanut epicutaneous immunotherapy patch, Viaskin Peanut (DBV Technologies, Montrouge, France), was under FDA review.…”