The clinically important impact of preschool food oral immunotherapy on parental quality of life

Abstract

RATIONALE: Our group previously showed the safety of peanut oral immunotherapy (OIT) in 270 preschool-aged children (0.4% had severe reactions). The impact of preschool OIT on parental quality of life (QoL) has not been previously described. METHODS: We enrolled preschool-aged children into OIT. The project was conducted in four clinics across Canada (Halifax, Winnipeg, Edmonton, Vancouver). The OIT protocol used capsules and/or food, and the maintenance dose was 300mg of protein daily. The 17-item Food Allergy Quality of Life-Parental Burden (FAQL-PB) questionnaire was administered to parents at baseline and end of build-up, and Wilcoxon signed-rank test was performed to compare the FAQL-PB scores between timepoints. RESULTS: Between May/2019-August/2020, 29 patients aged 9-32.3 months (58.6% males) completed OIT (28 peanut, 1 sesame), and FAQL-PB questionnaires. There was a significant improvement in FAQL-PB from baseline to end of build-up with a median change in score of -14 ((IQR: -33.5, -7.5); p<0.00001), representing a change of 0.82 in mean total score (> _0.5 is considered a minimal clinically important difference [MCID]). CONCLUSIONS: Our real-world study found that preschool OIT improves parent QoL from baseline to end of build-up (exceeding the MCID), even though families may be most fearful of potential reactions during this period based on reaction risks described in older children. This reduction in parental burden is most likely associated with the superior safety experienced by families of preschoolers. Future work will involve analyzing QoL at various timepoints during maintenance, to determine whether improvement in QoL holds over time.