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Casale TB, Warren C, Gupta S, Schuldt R, Wang R, Iqbal A, Seetasith A, Gupta R. The mental health burden of food allergies: Insights from patients and their caregivers from the Food Allergy Research & Education (FARE) Patient Registry. World Allergy Organ J 2024; 17:100891. [PMID: 38559493 PMCID: PMC10973659 DOI: 10.1016/j.waojou.2024.100891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Background Food allergies impose a large psychosocial burden, including mental, emotional, and social aspects, on both patients and their caregivers. Patients, caregivers, and their families often experience anxiety, isolation, and fear around food allergies. Objective To assess the real-world mental health burden of food allergies, using the Food Allergy Research & Education (FARE) Patient Registry (NCT04653324). Methods Self-reported data from patients with food allergies, and their caregivers, were analyzed from the FARE Food Allergy History and Mental Health Concerns surveys. Odds ratios were also calculated as a measure of association between patient food allergy characteristics and the likelihood of having mental health concerns or a formal mental health diagnosis. Results The FARE Patient Registry included 1680 patients/caregivers. Anxiety (54%) and panic (32%) were the most common emotions that patients reported as a result of eating the food that produced an allergic reaction. About two-thirds of patients reported mental health concerns related to food allergies (62%), including anxiety after an allergic reaction, anxiety about living with food allergies, and concerns about food avoidance. Caregivers also experienced fear for the safety of their children, and often sought mental health care to cope with worry related to caring for patients with food allergies. The likelihood of having food allergy-related mental health concerns was increased for patients experiencing more than 1 reaction per year (OR 1.68-1.90) and was lowered for patients having a formal mental health diagnosis (OR 0.43). Caregivers filling out the FARE survey for pediatric patients (OR 4.03) and experiencing food allergy-related mental health concerns (OR 2.36) were both significant predictors for having a formal mental health diagnosis. Conclusion Our study highlights a continuing unmet need for mental health screening and support as part of the management of patients with food allergies.
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Affiliation(s)
- Thomas B. Casale
- Division of Allergy and Immunology, University of South Florida, Tampa, FL, USA
- Food Allergy Research & Education (FARE), McLean, VA, USA
| | | | | | | | | | - Ahmar Iqbal
- Genentech, Inc., South San Francisco, CA, USA
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Ozturk CS, Merter OS, Sengul ZK. The experiences of mothers of children with food allergy: A qualitative study. J Pediatr Nurs 2023; 73:113-119. [PMID: 37659339 DOI: 10.1016/j.pedn.2023.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/17/2023] [Accepted: 08/19/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Food allergies adversely affect the quality of life of the child and family, as they require lifelong treatment and follow-up. This study aims to examine the experiences of mothers who have children with food allergies within the framework of the biopsychosocial-spiritual model. METHODS This study, using a qualitative research design, was carried out with mothers of children followed up with food allergy in the pediatric allergy outpatient clinic of a university hospital between December 15, 2022 and January 05, 2023. Purposive sampling method was used in the study and semi-structured interviews were conducted with 12 mothers. All interviews were audio recorded and transcribed. Inductive thematic analysis method was used. The study was written based on the COREQ checklist. FINDINGS Three themes, eight sub-themes, and 19 categories were identified: The effects of the disease on the physical health of the child and mother in the biological effects theme; psychosocial responses to disease, adaptation to treatment, future anxiety, coping strategies, and communication/interaction in the psychosocial effects theme; search for purpose-meaning in life and understanding belief/basic human values in the spiritual effects theme. DISCUSSION It has been concluded that food allergies affect maternal health extensively, especially in the psychosocial field, and that it affects family relationships, the time that mothers spare for themselves, and physical and spiritual health. APPLICATION TO PRACTICE The findings will be a guide for improving the quality of life of mothers followed up with food allergies and for the care and counseling support to be provided to mothers.
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Affiliation(s)
- Cigdem Sari Ozturk
- Gazi University, Nursing Faculty, Pediatric Nursing Department, Ankara, Turkey.
| | - Ozlem Selime Merter
- Firat University, Health Sciences Faculty, Nursing Department, Elazığ, Turkey
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Caner N, Efe YS, Söyünmez S, Bayat M. Managing food allergies at school: A qualitative study. J Pediatr Nurs 2023; 73:58-66. [PMID: 37647789 DOI: 10.1016/j.pedn.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The prevalence of childhood allergic diseases, including food allergies, has increased globally. Parents and children have experienced psychosocial and financial difficulties, decreased quality of life, anxiety, and depression in the management of food allergies in schools. PURPOSE The aim of the study was to determine the challenges experienced by mothers of children with food allergies during their children's school life. DESIGN A qualitative phenomenological study design was used. METHODS Online interviews were conducted with 9 mothers who have children with food allergies between June-August 2022. The data were analyzed using the content analysis method. The COREQ checklist was used in the study. RESULTS The ages of the mothers participating in the study ranged from 28 to 40. Four themes were generated from 75 codes: 1) Problems experienced in the process of utilizing health services, 2) Burden of care, 3) Coming out of the shell: The school process, and 4) Environmental and social perspective. CONCLUSIONS Mothers carried the burden of food allergy management during the school process, and the increased burden of care negatively impacted mothers emotionally, physically, and socially. Also, mothers were anxious about the safety of their school-age children with food allergies and their experiences with school administration, teachers, and other parents made it difficult for food allergy management in the school environment. CLINICAL RELEVANCE Children with chronic health problems such as food allergies need to be closely monitored by a health professional in school to ensure their safety. Nurses have a pivotal role in supporting families to address their child's food allergies competently, hence fostering positive health outcomes. This study showed that there was a need for the development of school health policies to ensure the safety of children with food allergies and to reduce anxiety and care burden among mothers.
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Affiliation(s)
- Nuray Caner
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Yağmur Sezer Efe
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Selin Söyünmez
- Erciyes University, Institute of Health Sciences, Child Health and Disease Nursing Department, Kayseri, Turkey.
| | - Meral Bayat
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
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Leung ASY, Cheng NS, Cheng JWCH, Pun J, Leung TF. Development and validation of assessment tools for food allergy-related knowledge and management confidence. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100098. [PMID: 37779529 PMCID: PMC10509832 DOI: 10.1016/j.jacig.2023.100098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 12/21/2022] [Accepted: 02/02/2023] [Indexed: 10/03/2023]
Abstract
Background Given the life-threatening nature of food allergy (FA), it is important to assess the level of knowledge among families with food-allergic patients and their ability to cope with anaphylaxis. This study constructed a FA knowledge questionnaire (FAKQ) and confidence in FA management skills (CIFAMS) questionnaire to assess understanding and attitudes toward FA management in food-allergic families. Methods Items from literature review and expert panel showing ≥80% content validity index and semantic equivalence were selected for translation into Chinese. These questionnaires underwent feasibility pilot testing followed by cross-sectional validation to assess their psychometric properties of internal consistency, test-retest reliability, and construct validity with a FA quality-of-life questionnaire and discriminant validity. Exploratory factor analysis was performed to confirm their factor structure. Results A total of 155 subjects (104 patients and 51 parents) completed a 20-item FAKQ and 10-item CIFAMS. Both tools showed acceptable internal consistency in baseline and retest groups. FAKQ and CIFAMS correlated for all subjects (P = .002) and for adults (P = .002), and similarly between CIFAMS and parent-reported FA independent measure (P = .005). Total score of FAKQ was sensitive to within-group differences of patients hospitalized for FA (P < .001). FAKQ and CIFAMS items were factored into 4 and 2 domains, respectively. Subjects scored the lowest on FAKQ items about signs of allergic reaction and CIFAMS items on epinephrine autoinjector use. Conclusion FAKQ and CIFAMS developed by our group are valid and reliable in assessing knowledge and confidence in FA management in patients and parents. These tools are crucial for formulating education programs and advocacy campaigns for FA.
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Affiliation(s)
- Agnes Sze Yin Leung
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
- Hong Kong Hub of Pediatric Excellence, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Nam Sze Cheng
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Jack Pun
- Department of English, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Ting Fan Leung
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong
- Hong Kong Hub of Pediatric Excellence, Chinese University of Hong Kong, Shatin, Hong Kong
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Santos MJL, Merrill K, Riediger N, Abrams EM, Piquemal N, Simons E, Protudjer JLP. Winnipeg-based elementary school teachers' perspectives on food allergy management: a qualitative analysis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:62. [PMID: 37452340 PMCID: PMC10347816 DOI: 10.1186/s13223-023-00798-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/22/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Food allergy affects 7-8% of children worldwide. Teachers supervise children in school, where most children spend their day. Yet, teachers have variable food allergy-related knowledge. OBJECTIVE We aimed to identify how Winnipeg-based elementary school teachers manage food allergy and prevent food-triggered allergic reactions in their classrooms and schools. METHODS Kindergarten-Grade 6 public and private school teachers, from Winnipeg, Canada, were interviewed virtually upon providing written informed consent. Interviews were recorded and transcribed verbatim. The study followed a pragmatic framework. Data were analysed via thematic analysis by multiple researchers. RESULTS We interviewed 16 teachers, who primarily identified as female (87.5%). Most teachers worked in public schools (87.5%) and, on average, had 5.8 years of teaching experience. We identified four themes within the data. Most teachers (68.9%) had direct or indirect experience with food allergy. Theme 1 described the minimal standardization and inconsistent enforcement of food allergy policies between and within schools. Teachers also had varied food allergy knowledge. Theme 2 reflected teachers' variable confidence/perceived knowledge towards food allergy management, including feeling of stress and anxiety. Theme 3 captured the lack of standardized food allergy education for teachers, and concerns about the adequacy of the current provincial program. Theme 4 described how teachers spoke of relying on other school staff, families and students to have effective communication. CONCLUSION Teachers' food allergy management was informed by their knowledge and lived experience, guided by their school policies and individualized students' needs. Teachers identified gaps in knowledge and communication, and desired more training and resources.
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Affiliation(s)
- Mae Jhelene L Santos
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Kaitlyn Merrill
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Natalie Riediger
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Section of Allergy, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | | | - Elinor Simons
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Section of Allergy, Department of Pediatrics & Child Health, University of Manitoba, Winnipeg, Canada
| | - Jennifer L P Protudjer
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
- George and Fay Yee Centre for Healthcare Innovation, 501G-715 McDermot Avenue, Winnipeg, MB, Canada.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Chong AC, Diwakar L, Kaplan CM, Fox AT, Abrams EM, Greenhawt M, Oppenheimer JJ, Shaker MS. Provision of Food Allergy Care in the United Kingdom and United States: Current Issues and Future Directions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:2054-2066. [PMID: 36990429 DOI: 10.1016/j.jaip.2023.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
Food allergy (FA) is a growing issue worldwide. The United Kingdom and United States are high-income, industrialized countries with reported increases in FA prevalence over the past few decades. This review compares delivery of FA care in the United Kingdom and United States and each country's response to the heightened demand and disparities for FA services. In the United Kingdom, allergy specialists are scarce and general practitioners (GPs) provide most allergy care. Whereas the United States has more allergists per capita than the United Kingdom, there is still a shortage of allergy services owing to the greater reliance on specialist care for FA in America and wide geographic variation in access to allergist services. Currently, generalists in these countries lack the specialty training and equipment to diagnose and manage FA optimally. Moving forward, the United Kingdom aims to enhance training for GPs so they may provide better quality frontline allergy care. In addition, the United Kingdom is implementing a new tier of semi-specialized GPs and increasing cross-center collaboration through clinical networks. The United Kingdom and United States aim to increase the number of FA specialists, which is critical at a time of rapidly expanding management options for allergic and immunologic diseases requiring clinical expertise and shared decision-making to select appropriate therapies. While these countries aim to grow their supply of quality FA services actively, further efforts to build clinical networks and perhaps recruit international medical graduates and expand telehealth services are necessary to reduce disparities in access to care. For the United Kingdom in particular, increasing quality services will require additional support from the leadership of the centralized National Health Service, which remains challenging.
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Affiliation(s)
- Albert C Chong
- Keck School of Medicine, University of Southern California, Los Angeles, Calif
| | - Lavanya Diwakar
- Department of Immunology, University Hospital of North Midlands, Stoke-on-Trent, United Kingdom; Department of Health Economics, University of Birmingham, Birmingham, United Kingdom
| | - Cameron M Kaplan
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, Los Angeles, Los Angeles, Calif
| | - Adam T Fox
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Elissa M Abrams
- Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Allergy and Immunology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colo
| | - John J Oppenheimer
- Department of Internal Medicine, Pulmonary and Allergy, UMDJ Rutgers University School of Medicine, Newark, NJ
| | - Marcus S Shaker
- Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Department of Pediatrics, Dartmouth Geisel School of Medicine, Hanover, NH; Department of Medicine, Dartmouth Geisel School of Medicine, Hanover, NH.
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Graf MD, Wasser H, Lynn MR, Karp SM, Lutenbacher M, Hodges EA. Parental food selection questionnaire - Infant version. Appetite 2023; 186:106548. [PMID: 36977445 PMCID: PMC10286103 DOI: 10.1016/j.appet.2023.106548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/28/2023]
Abstract
PURPOSE Complementary feeding practices (CFPs) are associated with health outcomes (e.g., obesity and food allergies). Understanding how parents select foods for their infant is limited. This study's purpose was to develop a psychometrically sound measure of parents' food selection motives for their infant during the complementary feeding period. METHODS Development and testing of the Parental Food Slection Questionnaire-Infant Version (PFSQ-I) occurred in three phases. English-speaking, U.S. mothers of healthy infants, aged 6-19 months old participated in a semi-structured, face-to-face interview (Phase 1) or a web-based survey (Phases 2 & 3). Phase 1 was a qualitative study of maternal beliefs and motives surrounding complementary feeding. Phase 2 involved adaptation and exploratory factor analysis of the original Food Choice Questionnaire (Steptoe et al., 1995). Phase 3 involved validity testing of the relationships among PFSQ-I factors and CFPs (timing/type of complementary food introduction, frequency of feeding method, usual texture intake, and allergenic food introduction) using bivariate analyses, and multiple linear and logistic regression analyses. RESULTS Mean maternal age was 30.4 years and infant age was 14.1 months (n = 381). The final structure of the PFSQ-I included 30 items and 7 factors: Behavioral Influence, Health Promotion, Ingredients, Affordability, Sensory Appeal, Convenience, and Perceived Threats (Cronbach's α = 0.68-0.83). Associations of factors with CFPs supported construct validity. DISCUSSION The PFSQ-I demonstrated strong initial psychometric properties in a sample of mothers from the U.S. Mothers who rated Behavioral Influence as more important were more likely to report suboptimal CFPs (e.g., earlier than recommended complementary food introduction, delayed allergenic food introduction, and prolonged use of spoon-feeding). Additional psychometric testing in a larger, more heterogenous sample is needed, along with examination of relationships between PFSQ-I factors and health outcomes.
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Affiliation(s)
- Michelle Dorsey Graf
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA.
| | - Heather Wasser
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Mary R Lynn
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Sharon M Karp
- School of Nursing, Vanderbilt University, Nashville, TN, 37235, USA
| | | | - Eric A Hodges
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
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Devonshire A, Gautam Y, Johansson E, Mersha TB. Multi-omics profiling approach in food allergy. World Allergy Organ J 2023; 16:100777. [PMID: 37214173 PMCID: PMC10199264 DOI: 10.1016/j.waojou.2023.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/05/2023] [Accepted: 04/05/2023] [Indexed: 05/24/2023] Open
Abstract
The prevalence of food allergy (FA) among children is increasing, affecting nearly 8% of children, and FA is the most common cause of anaphylaxis and anaphylaxis-related emergency department visits in children. Importantly, FA is a complex, multi-system, multifactorial disease mediated by food-specific immunoglobulin E (IgE) and type 2 immune responses and involving environmental and genetic factors and gene-environment interactions. Early exposure to external and internal environmental factors largely influences the development of immune responses to allergens. Genetic factors and gene-environment interactions have established roles in the FA pathophysiology. To improve diagnosis and identification of FA therapeutic targets, high-throughput omics approaches have emerged and been applied over the past decades to screen for potential FA biomarkers, such as genes, transcripts, proteins, and metabolites. In this article, we provide an overview of the current status of FA omics studies, namely genomic, transcriptomic, epigenomic, proteomic, exposomic, and metabolomic. The current development of multi-omics integration of FA studies is also briefly discussed. As individual omics technologies only provide limited information on the multi-system biological processes of FA, integration of population-based multi-omics data and clinical data may lead to robust biomarker discovery that could translate into advances in disease management and clinical care and ultimately lead to precision medicine approaches.
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Affiliation(s)
- Ashley Devonshire
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Yadu Gautam
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Elisabet Johansson
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Tesfaye B. Mersha
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Wang S, Zhang R, Li X, Gao Y, Dai N, Wei Y, Liu L, Xing Y, Li Z. Relationship between maternal-infant gut microbiota and infant food allergy. Front Microbiol 2022; 13:933152. [PMID: 36419421 PMCID: PMC9676664 DOI: 10.3389/fmicb.2022.933152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 10/10/2022] [Indexed: 08/26/2023] Open
Abstract
The gut microbiota plays a crucial role in food allergies. We sought to identify characteristics of the maternal gut microbiota in the third trimester and the infant gut microbiota in early life and the association of these microbiotas with infant food allergy. A total of 68 healthy pregnant women and their full-term newborns were selected from a cohort of 202 mother-infant pairs; among them, 24 infants had been diagnosed with food allergy within 1 year of age, whereas 44 infants were healthy without allergic symptoms. We collected 65 maternal fecal samples before delivery and 253 infant fecal samples at five time points following birth. Fecal samples were microbiologically analyzed using 16S rRNA gene sequencing. Holdemania abundance in the maternal gut microbiota in the third trimester was significantly higher in the non-allergy group than in the food allergy group (P = 0.036). In the infant gut microbiota, Holdemania was only found in meconium samples; its abundance did not differ significantly between the two groups. The change in the abundance of Actinobacteria over time differed between the non-allergy and food allergy groups (FA, P = 0.013; NA, P = 9.8 × 10-5), and the change in the abundance of Firmicutes over time differed significantly in the non-allergy group (P = 0.023). The abundances of genera Anaerotruncus, Roseburia, Ruminococcus, and Erysipelotricaceae were significantly different between the non-allergy and food allergy groups at different time points. Our results showed that maternal carriage of Holdemania during the third trimester strongly predicted the absence of food allergies in infants; there was no correlation between the presence of food allergies and the abundance of Holdemania in the infant gut microbiota. More dynamic fluctuations in phyla Actinobacteria and Firmicutes early in life protect against food allergy. Thus, the enrichment of the infant gut microbiota early in life with short-chain fatty acid-producing bacteria may be beneficial in preventing the development of food allergies in infants.
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Affiliation(s)
- Shuo Wang
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Rui Zhang
- Department of Pediatrics, Fujian Provincial Maternity and Children Hospital, Fuzhou, China
| | - Xinyue Li
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Yajuan Gao
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Nini Dai
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Yuan Wei
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Luyan Liu
- Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China
| | - Yan Xing
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
| | - Zailing Li
- Department of Pediatrics, Peking University Third Hospital, Beijing, China
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Ross N, Dalke S, Filuk S, Kulbaba B, Marks D, St-Vincent JA, Simons E. It takes a village: perceptions of Winnipeg parents, students, teachers and school staff regarding the impact of food allergy on school-age students and their families. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2022; 18:47. [PMID: 35689271 PMCID: PMC9188203 DOI: 10.1186/s13223-022-00682-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 05/03/2022] [Indexed: 11/21/2022]
Abstract
Background The entire school community contributes to the safety of students with food allergy. We sought to determine the food allergy perceptions and education needs of parents, students and school staff, with the goal of enhancing food allergy education in schools. Methods With ethics approval from the University of Manitoba and participating school divisions, elementary school principals emailed SurveyMonkey® Questionnaire Links to their parent/caregiver contact list and school staff. We compared anonymous responses of parents of children with and without food allergy, students with and without food allergy, and parents and school staff using chi-squared tests. Results Participants included 561 parents of school-age children (ages 7–12 years, 19% with food allergy), 61 students (23% with food allergy), and 203 school staff (62% teachers, 88% with experience managing food allergies in the classroom). Parents of children with and without food allergy considered food allergy when sending food to school (98% vs. 96%, p = 0.39). More parents of children with food allergy thought that greater information and awareness about food allergy was needed (74% vs. 44%, p < 0.0001). Students with food allergy were most interested (100%) in having other students learn not to bully and how to help during a reaction. Students without food allergy were most interested in learning how to prevent a reaction (70%). Fewer parents than school staff thought that food allergies in the classroom impacted teachers’ time (2.1% vs. 21%, p < 0.0001) and that teachers knew how to treat allergic reactions to foods (34% vs. 94%, p < 0.0001). More parents than school staff thought that banning foods from classrooms kept allergic students safe (65% vs. 34%, p = 0.006) and that having a Food Allergy Educator speak at school would be helpful (99% vs. 67%, p < 0.0001). Conclusions Food allergy education is necessary for the entire school community and should include parents of school-aged children with and without food allergy, students with and without food allergy, and teachers and school staff. These members of the school community recognized their own and others’ needs for increased food allergy education and awareness in the school setting. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-022-00682-2.
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Affiliation(s)
- Nancy Ross
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Sandra Dalke
- Unified Referral and Intake Service, Manitoba Health, 300 Carlton Street, Winnipeg, MB, R3B 3M9, Canada
| | - Shauna Filuk
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Bev Kulbaba
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Diane Marks
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Jo-Anne St-Vincent
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada
| | - Elinor Simons
- Children's Allergy & Asthma Education Centre (CAAEC), Health Sciences Centre, FE-125-685 William Avenue, Winnipeg, MB, R3E 0Z2, Canada. .,Section of Allergy and Clinical Immunology, Department of Pediatrics and Child Health, University of Manitoba and Children's Hospital Research Institute of Manitoba, 504B-715 McDermot Avenue, Winnipeg, MB, R3E 3P4, Canada.
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Memauri TD, Golding MA, Gerdts JD, Simons E, Abrams EM, Elliott SJ, Roos LE, Kim H, Protudjer JL. The perceived impact of pediatric food allergy on mental health care needs and supports: A pilot study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2022; 1:67-72. [PMID: 37780589 PMCID: PMC10509884 DOI: 10.1016/j.jacig.2022.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 10/03/2023]
Abstract
Background Evidence suggests a mental health impact of food allergy on affected children and their families; however, little is known about health care professionals' understanding of these impacts and the resources available to patients and their families. Objective Our aim was to conduct a pilot study examining health care professionals' perceptions of the psychosocial and financial burden of food allergy to identify gaps in education and resources and thus better support families with food allergy moving forward. Methods Between February 20 and November 19, 2020, we conducted audiorecorded interviews (n = 6) and profession-specific focus groups (n = 2 [representing 7 individuals]). The participants included pediatric allergists, allergy nurse educators, and clinical dietitians who were directly involved in pediatric food allergy care. The interviews were recorded and transcribed verbatim. Thematic analysis was subsequently applied to identify the main themes. Results Our study consisted of an interdisciplinary group of Manitoban health care providers (N = 13) who were directly involved with pediatric food allergy care. We identified 3 main themes from these interviews: anxiety among families with food allergy, which is a common comorbidity; limited resources available within current public infrastructure; and empowerment through education. These themes describe issues surrounding access to information and resources and how this can affect anxiety and parenting styles among families with food allergy. Conclusions Health care professionals perceive that many families experience anxiety as a result of their child's food allergy. They further advocate that access to information and suitability of public resources be considered when planning for related programs.
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Affiliation(s)
- Tessa D. Memauri
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Michael A. Golding
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Jennifer D. Gerdts
- Section of Allergy and Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elinor Simons
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Elissa M. Abrams
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Western Ontario, London, Ontario, Canada
| | - Susan J. Elliott
- Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Harold Kim
- University of Waterloo, Waterloo, Ontario, Canada
| | - Jennifer L.P. Protudjer
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- University of Western Ontario, London, Ontario, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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12
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Wilton EP, Luke AK, Gladstone TR, Lahoud AA, Biscarri Clark SD, Flessner CA. Psychometric Properties of a Measure Assessing Anxiogenic Parenting Practices in Food Allergy. J Pediatr Psychol 2022; 47:769-784. [DOI: 10.1093/jpepsy/jsac016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
Pediatric food allergy represents a significant public health burden. In order to avoid allergen consumption, adequate management requires daily vigilance and involvement from parents, frequently leading to increased parental anxiety. While specific anxiogenic parenting practices (i.e., parenting behaviors which may aid in the development and/or exacerbation of childhood anxiety) have been documented within this population, to this point, these behaviors have not been systematically measured.
Objectives
The current study aimed to develop and examine a parent-report scale designed to measure anxiogenic parenting behaviors related to food allergy.
Methods
Participants included 177 parents of children with food allergy recruited online using Amazon Mechanical Turk (mTurk). An exploratory factor analysis was conducted to determine the factor structure of the newly developed scale. Subsequently, psychometric properties (e.g., construct validity) were examined via correlational analyses.
Results
Results indicated a 24-item, 3 factor (Factor 1: Involvement in Food Allergy; Factor 2: Worry about Food Allergy; Factor 3: Autonomy Promotion) scale, which accounted for 53.11% of the total variance. The Kaiser–Meyer–Olkin measure was acceptable, KMO = 0.872 and Bartlett’s test of sphericity indicated sufficient correlations between items (χ2 (378) = 2568.95). All subscales demonstrated strong internal consistency (Involvement in Food Allergy: α = .880; Worry about Food Allergy: α = .892; Autonomy Promotion α = .796) as well as convergent and discriminant validity.
Conclusions
Results support the overall psychometric properties of the scale. Interpretations, limitations, and future directions are discussed.
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Affiliation(s)
- Emily P Wilton
- Department of Psychological Sciences, Kent State University, Kent Hall, Kent, OH, USA
| | | | - Theresa R Gladstone
- Department of Psychological Sciences, Kent State University, Kent Hall, Kent, OH, USA
| | - Ashley A Lahoud
- Department of Psychological Sciences, Kent State University, Kent Hall, Kent, OH, USA
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13
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Protudjer JLP. Scales of Food Allergy Anxiety (SOFAA): A Novel Tool to Assess Anxiety Among Children with Food Allergy and Their Caregivers. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:170-171. [PMID: 35000731 DOI: 10.1016/j.jaip.2021.10.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 06/14/2023]
Affiliation(s)
- Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
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14
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Golding MA, Gunnarsson NV, Middelveld R, Ahlstedt S, Protudjer JLP. A scoping review of the caregiver burden of pediatric food allergy. Ann Allergy Asthma Immunol 2021; 127:536-547.e3. [PMID: 33971359 DOI: 10.1016/j.anai.2021.04.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Although a number of articles have described the psychosocial impact of raising a child with a food allergy, recent attempts at synthesizing this literature have been narrow in focus or methodologically limited. Consequently, this study aimed to synthesize both the quantitative and qualitative literature to achieve a better understanding of the psychosocial and financial burdens faced by families who raise children with food allergy. DATA SOURCES Searches were performed on PubMed, Scopus, PsycInfo, and Cumulative Index to Nursing and Allied Health Literature databases for articles related to the psychosocial and financial burden experienced by individuals who care for a child with food allergy. STUDY SELECTIONS English language, original research articles were included in this review. RESULTS A total of 54 articles were deemed eligible for review. Results from the quantitative literature revealed that parents of children with food allergy (ie, food allergy and food protein-induced enterocolitis, proctocolitis, and enteropathy) consistently reported lower quality of life than their comparison groups. Within-group analyses suggest that this burden is increased for parents who manage multiple food allergies, severe food allergy, and comorbid allergic conditions. Thematic synthesis of the qualitative literature suggests that the psychosocial burden shouldered by parents of children with food allergy stems, in part, from the unpredictable threat of exposure and the practical and social burdens of managing a food allergy. In addition to psychosocial burdens, a small but growing body of literature suggests that families with food allergy also incur greater financial costs. CONCLUSION Findings suggest that pediatric food allergy imposes considerable burdens on parents both quantitatively and qualitatively.
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Affiliation(s)
- Michael A Golding
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Nina V Gunnarsson
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Roelinde Middelveld
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
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15
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Liu Q, Zhou Y, Gao Y, Shu Z, Zhang J, Liu H, Cao M, Liu G, Sun J. Degraded Porphyra haitanensis sulfated polysaccharide relieves ovalbumin-induced food allergic response by restoring the balance of T helper cell differentiation. Food Funct 2021; 12:4707-4719. [PMID: 33929475 DOI: 10.1039/d1fo00335f] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We previously described that Porphyra haitanensis sulfated polysaccharide (PHSP) maintains the balance of pro-inflammation and immunosuppression. However, it is unclear whether degraded PHSP (DPHSP) still shows the immunomodulatory activity. Here, we degraded PHSP by four different methods alone or combined in pairs, and the results showed that the molecular weight and viscosity of DPHSP were significantly decreased, while the main chemical bonds and functional structure were consistent with those of PHSP. We then investigated the immunomodulatory function of DPHSP in vitro and in vivo. Actually, DPHSP enhances the inhibitory effects on mast cell activation and improves the suppression activity of PHSP on the food anaphylactic response. In an ovalbumin-induced food allergy mouse model, the production of allergic mediators and cytokines (interleukin-4 and 13, and interferon-γ) was inhibited by DPHSP. Meanwhile, DPHSP had a stronger ability to up-regulate the differentiation of regulatory T (Treg) cells and its related cytokines. These results suggested that DPHSP showed a better anti-food allergic ability than PHSP by regulating T helper cell balance and promoting Treg cell differentiation, which indicates that DPHSP is a novel potential nutrient component against food allergy.
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Affiliation(s)
- Qingmei Liu
- Allergy Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
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16
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Hurst K, Gerdts J, Simons E, Abrams EM, Protudjer JLP. Social and financial impacts of food allergy on the economically disadvantaged and advantaged families: A qualitative interview study. Ann Allergy Asthma Immunol 2021; 127:243-248. [PMID: 33894341 DOI: 10.1016/j.anai.2021.04.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/28/2021] [Accepted: 04/16/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND Differences in the qualitatively-perceived burden of food allergy based on economic disadvantages have not been previously described. OBJECTIVE To describe the perceptions of food allergy-related social and financial issues of families who have a child with food allergy, considering the similarities and differences between economically advantaged and disadvantaged families. METHODS From March to July 2019, we interviewed parents of children being followed up for food allergy at a tertiary allergy clinic in central Canada. Interviews were recorded, transcribed, and analyzed thematically. Economic groups were categorized on the basis of the national cutoffs for low-income after-tax dollars. RESULTS We interviewed 18 parents (17 [94.4% mothers]) of whom 6 (33.3%) were economically disadvantaged, and who represented 25 children (10 [40.0%] girls) with food allergy. We identified 3 common themes: food allergy had (1) resulted in the need to teach others in addition to contributing to tensions in relationships; (2) increased time costs for food shopping and preparation; and (3) contributed to concerns securing qualified child care. We also identified 2 divergent themes that underscored how this burden was perceived between economic groups: (1) medications and medical appointments are costly or inconvenient; and (2) allergy-friendly food choices: single vs several sources and servings. CONCLUSION Despite some qualitative similarities in the social and financial burdens of food allergy, there are some notable differences between economic groups that underscore the need for further discussions surrounding the related policy.
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Affiliation(s)
- Kim Hurst
- Queen's University, Kingston, Canada
| | | | - Elinor Simons
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Elissa M Abrams
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Section of Allergy, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Jennifer L P Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada; Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
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17
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Greiwe J. Using oral food challenges to provide clarity and confidence when diagnosing food allergies. JOURNAL OF FOOD ALLERGY 2021; 3:3-7. [PMID: 39022631 PMCID: PMC11250530 DOI: 10.2500/jfa.2021.3.210002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
A verified food allergy can be an impactful life event that leads to increased anxiety and measurable effects on quality of life. Allergists play a key role in framing this discussion and can help alleviate underlying fears by promoting confidence and clarifying safety concerns. Correctly diagnosing a patient with an immunoglobulin E (IgE) mediated food allergy remains a nuanced process fraught with the potential for error and confusion. This is especially true in situations in which the clinical history is not classic, and allergists rely too heavily on food allergy testing to provide a confirmatory diagnosis. A comprehensive medical history is critical in the diagnosis of food allergy and should be used to determine subsequent testing and interpretation of the results. Oral food challenge (OFC) is a critical procedure to identify patients with an IgE-mediated food allergy when the history and testing are not specific enough to confirm the diagnosis and can be a powerful teaching tool regardless of outcome. Although the safety and feasibility of performing OFC in a busy allergy office have always been a concern, in the hands of an experienced and trained provider, OFC is a safe and reliable procedure for patients of any age. With food allergy rates increasing and analysis of recent data that suggests that allergists across the United States are not providing this resource consistently to their patients, more emphasis needs to be placed on food challenge education and hands-on experience. The demand for OFCs will only continue to increase, especially with the growing popularity of oral immunotherapy programs; therefore, it is essential that allergists become familiar with the merits and limitations of current testing modalities and open their doors to using OFCs in the office.
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Affiliation(s)
- Justin Greiwe
- From the Bernstein Allergy Group, Inc, Cincinnati, Ohio, and
- Division of Immunology/Allergy Section, Department of Internal Medicine, The University of Cincinnati College of Medicine, Cincinnati, Ohio
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18
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Golding MA, Simons E, Abrams EM, Gerdts J, Protudjer JLP. The excess costs of childhood food allergy on Canadian families: a cross-sectional study. Allergy Asthma Clin Immunol 2021; 17:28. [PMID: 33691771 PMCID: PMC7943937 DOI: 10.1186/s13223-021-00530-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/19/2021] [Indexed: 12/21/2022] Open
Abstract
Background The impact of childhood food allergy on household costs has not been examined in Canada. The current study sought to examine differences in direct, indirect, and intangible costs among Canadian families with and without a food-allergic child. Methods Families with a child with a specialist-diagnosed food allergy (cases) were recruited from two tertiary pediatric allergy clinics in the Province of Manitoba, Canada, and matched, based on age and sex, to families without a food-allergic child (controls). Cost data for the two groups were collected via an adapted version of the Food Allergy Economic Questionnaire (FA-EcoQ). Consideration was given to income, defined as above vs. below the provincial annual median income. Results Results from 35 matched case/control pairs revealed that while total household costs did not significantly differ between cases and controls, food-allergic families did incur higher direct costs ($12,455.69 vs. $10,078.93, p = 0.02), which were largely attributed to spending on food. In contrast, cases reported lower, but not statistically significant, total indirect costs compared to controls ($10,038.76 vs. $12,294.12, p = 0.06). Families also perceived their food-allergic child as having poorer quality of life relative to their healthy peers. Lastly, stratification of the analyses by annual income revealed several differences between the higher and lower income groups. Conclusions Relative to families without a food-allergic child, food-allergic families incurred higher direct costs across a number of different areas. Supplementary Information The online version contains supplementary material available at 10.1186/s13223-021-00530-9.
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Affiliation(s)
- Michael A Golding
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3M 3P4, Canada.,Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3M 3P4, Canada.,Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
| | - Elissa M Abrams
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3M 3P4, Canada.,Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada.,Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | | | - Jennifer L P Protudjer
- The Children's Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, R3M 3P4, Canada. .,Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada. .,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada. .,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden. .,Food and Human Nutritional Sciences, The University of Manitoba, Winnipeg, MB, Canada.
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19
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Stockhammer D, Katelaris CH, Simpson MD, Vanniasinkam T. Parent perceptions in managing children with food allergy: An Australian perspective. World Allergy Organ J 2020; 13:100468. [PMID: 33133333 PMCID: PMC7578552 DOI: 10.1016/j.waojou.2020.100468] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Food allergy affects up to 10% of Australian children, and living with food allergic children can be challenging for parents. This study explored parental perceptions and knowledge as they navigate a new reality of keeping their child safe. METHODS Parents of children with food allergies completed an online food allergy survey in 2015. Questions explored health knowledge, skills, and attitudes (KSAs) as well as quality of life (QoL) through the inclusion of the Food Allergy Quality of Life - Parental Burden instrument (FAQL-PB). Notification of the survey included advertisements to more than 700 randomly selected Australia-wide preschools, 44 allergy specialists, and Allergy & Anaphylaxis Australia. Responses were tabulated and analysed. RESULTS Of the 400 participants who logged on, 357 commenced the survey and 318 finished. Questionnaire analysis showed that 44.1% of parents (n = 135) hesitated to use an adrenaline auto-injector and may be influenced by a classification system where symptom severity is not universally understood. While 79% would sign up to a national Anaphylaxis Registry, intention to participate in clinical trials using vaccines was disclosed by only 56%. Allergen labelling and community acceptance continue to be the most challenging aspects of managing a food allergy, and 50% of parents reported that food allergy played a role in choosing a preschool or primary school. Overall, quality of life for participants was influenced more by gender (male) and age of the child than where they lived - capital city or regional location; however, regional participants were more frustrated over lack of appreciation relating to the seriousness of food allergy (p = 0.010). CONCLUSION Results highlight the need for educational strategies for both the food allergy community and public, particularly in regional areas, since there is a perceived lack of appreciation as to the seriousness of food allergy. Educational resources and relevant networks are required to support parents and caregivers in the management of children with food allergy.
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Key Words
- ABC, Australian Broadcasting Corporation
- ANOVA, Analysis of variance
- CA, California
- FAQL-PB
- FAQL-PB, Food Allergy Quality of Life – Parental Burden
- Food allergy
- GP/GPs, General Practitioner(s)
- KSA, Knowledge, Skills, Attitudes
- LOC, Locus of control
- NSW, New South Wales, Australia
- NVivo Pro, NVivo Pro, QSR International Pty Ltd
- PAF, Principal Axis Factoring
- PRIME7, Prime Television Australia
- Parental burden
- QoL, Quality of Life
- Quality of life
- SPSS/IBM SPSS Statistics, IBM Statistical Package for the Social Sciences
- VIC, Victoria, Australia
- WIN Television, WIN Corporation Australia
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Affiliation(s)
- Debbi Stockhammer
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia
| | | | | | - Thiru Vanniasinkam
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, Australia
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20
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Protudjer JLP, Golding M, Salisbury MR, Abrams EM, Roos LE. High anxiety and health-related quality of life in families with children with food allergy during coronavirus disease 2019. Ann Allergy Asthma Immunol 2020; 126:83-88.e1. [PMID: 32950685 PMCID: PMC7498414 DOI: 10.1016/j.anai.2020.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/18/2020] [Accepted: 09/11/2020] [Indexed: 11/18/2022]
Abstract
Background Food allergy has a known effect on quality of life (QoL), but this has not been extensively studied during the coronavirus disease 2019 pandemic. Objective To characterize the levels of anxiety of mothers of children aged 0 to 8 years with food allergy compared with families of children without a food allergy and the health-related QoL among children with food allergy during the coronavirus disease 2019 pandemic. Methods In a mixed-methods study, Canadian mothers of children aged 0 to 8 years with (cases) and without (controls) food allergy provided demographic data and completed age-appropriate anxiety questionnaires between April 14, 2020, and April 28, 2020. The cases also provided food allergy-related data and completed the Food Allergy Quality of Life Questionnaire. In-depth interviews were subsequently conducted with purposefully selected cases. Results In a total of 580 participants, 5.5% were cases and 94.5% were controls. For mothers of children aged 0 to 1.5 years, anxiety levels did not differ between cases and controls. For mothers of children aged 1.5 to 8 years, anxiety levels were higher in cases vs controls (P < .05). Among the cases, neither overall nor domain-specific Food Allergy Quality of Life Questionnaire scores differed between age groups (0-3 vs 4-7 years), even after adjustment for confounding variables, including childcare during the pandemic. Qualitatively, the following 3 themes were identified: unexpected challenges of food shopping; less food-related food anxiety during the pandemic; and differences and delays in food allergy testing and therapy. Conclusion Mothers of children with food allergy reported high anxiety and poor health-related QoL. Yet, qualitatively, day-to-day food allergy management was better during the pandemic.
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Affiliation(s)
- Jennifer L P Protudjer
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.
| | - Michael Golding
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Marlee R Salisbury
- Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Elissa M Abrams
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Leslie E Roos
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; The Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
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21
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Kachru R. Psychosocial issues and quality of life associated with food allergy. JOURNAL OF FOOD ALLERGY 2020; 2:95-98. [PMID: 39022158 PMCID: PMC11250222 DOI: 10.2500/jfa.2020.2.200025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
The day-to-day challenges involved in caring for a child with food allergies can be a significant stress within a family. As the child with a food allergy grows up, developmental changes as well as external influences such as bullying and peer pressure can further influence these stressors. When the child with a food allergy is young, the family may be limited on where they can vacation or go out to restaurants, which can cause tension and frustration within the family. Hypervigilance and fear of accidental exposure to the allergen takes an emotional and physical toll on the child with a food allergy and the child's family. Socially, children with a food allergy may have to limit participation in school events, parties, or camps. These limitations can cause feelings of isolation for the child and feelings of guilt for the parents. As the child becomes an adolescent and young adult (AYA), increased autonomy of dining options and a desire to fit in with peers can trigger higher risk-taking behavior, which can be a source of anxiety for the AYA as well as the caregivers. The aim of this review was to describe potential negative psychosocial impacts of having a food allergy for the family. Data were reviewed from a literature search of medical literature data bases between 2010 and 2020 by using the search terms "food allergy," "psychosocial," "anxiety," and" quality of life." As we better recognize the psychosocial issues associated with food allergies, we will have a better ability to develop effective interventions to improve the quality of life for these families.
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Affiliation(s)
- Rita Kachru
- From the David Geffen School of Medicine, University of California Los Angeles, Santa Monica, California
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