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Aaneland H, Larsen MH, Helseth S, Wahl AK. Quality Appraisal of Quality of Life Research in Children and Adolescents with Food Allergy: A Systematic Review. Int Arch Allergy Immunol 2024:1. [PMID: 38885630 DOI: 10.1159/000539113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/05/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Quality of life (QOL) and health-related quality of life (HRQOL) in children and adolescents with food allergies have been an important and steadily growing field of research for the past 20 years. There seem to be conceptual and methodological challenges that might influence the face validity of QOL and HRQOL research in general health research, but this has not been investigated in pediatric and adolescent food allergy research up until now. The aim of this study was to perform a systematic review of the QOL and HRQOL studies on food allergy in children and adolescents under the age of 18. METHODS The systematic review was conducted on studies purporting to measure QOL or HRQOL in children and adolescents with food allergies. The literature search was developed in Ovid MEDLINE and databases used in the review were Embase, Cochrane Database of Systematic Reviews, CINAHL, and Scopus. Studies were evaluated based on a set of face validity criteria developed by Gill and Feinstein in 1994 and refined by Moons et al. in 2004. RESULTS Out of 61 studies eligible for the review, 11 (18%) defined QOL or HRQOL and two distinguished QOL from HRQOL. The Food Allergy Quality of Life (FAQLQ) instrument series is the most frequently used HRQOL measurement among the studies included. QOL and HRQOL were employed interchangeably in half of the studies, some of them also using a third term in addition. CONCLUSION Our findings lead to the conclusion that the research field investigated contains methodological and conceptual shortcomings regarding QOL and HRQOL. An increased awareness toward the terminology as well as consideration of points to reflect upon will be beneficial, as this will also improve the validity of future studies.
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Affiliation(s)
- Hilde Aaneland
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marie Hamilton Larsen
- Department of Postgraduate Studies, Lovisenberg Diaconal University College, Oslo, Norway
| | - Sølvi Helseth
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Astrid Klopstad Wahl
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Kivistö JE, de Blok BF, Protudjer JLP, Ojaniemi I, Karjalainen J, Huhtala H, Dunn Galvin A. Validation of the Finnish version of the food allergy quality of life questionnaire-parent form (F-FAQLQ-PF). Acta Paediatr 2024; 113:91-97. [PMID: 37548086 DOI: 10.1111/apa.16937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/08/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
AIM Specific questionnaires about food allergy and health-related quality of life (HRQoL) have been developed and validated in several languages, but not Finnish. We aimed to validate the Finnish Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) for children under age 13 years. METHODS The original FAQLQ-PF and Food Allergy Independent Measure (FAIM) were translated into Finnish per World Health Organisation guidelines and tested by 72 parents of children under age 13 years with suspected severe peanut or tree nut allergy who were recruited at Allergy Centre in Tampere University Hospital in Tampere, Finland. We calculated the construct validity of the questionnaire by calculating the coefficients between the two measures and used Cronbach's alpha to establish the internal consistency. RESULTS The FAQLQ-PF showed strong correlations with domain structure and internal consistency, based on Spearman's correlations (rho) for the HRQoL questions, FAIM questions and FAIM mean values. The total questionnaire score correlated significantly with the mean FAIM (rho = 0.95, p < 0.001) and individual FAIM questions. The FAQLQ-PF and domains had good or excellent internal consistency (Cronbach's alpha >0.70). CONCLUSION The Finnish FAQLQ-PF demonstrated good construct validity and excellent internal consistency for measuring food allergy HRQoL in children under age 13 years.
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Affiliation(s)
- J E Kivistö
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Tampere Center for Child Health Research, University of Tampere, Tampere, Finland
| | - B Flokstra de Blok
- General Practitioners Research Institute, Groningen, The Netherlands
- University Medical Center Groningen, Groningen Research Institute Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands
- University Medical Center Groningen, Beatrix Children's Hospital, Department of Pediatric Pulmonology and Pediatric Allergology, University of Groningen, Groningen, The Netherlands
| | - J L P Protudjer
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- 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
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - I Ojaniemi
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - J Karjalainen
- Allergy Centre, Tampere University Hospital, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - H Huhtala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - A Dunn Galvin
- School of Applied Psychology, University College Cork, Cork, Ireland
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Arasi S, Fiocchi A. The development of the DEFASE project. Curr Opin Allergy Clin Immunol 2023; 23:252-261. [PMID: 37185831 DOI: 10.1097/aci.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW To familiarize the reader with the milestones of the DEFASE (Definition of Food Allergy Severity) project. This World Allergy Organization (WAO) initiative has recently developed the first international consensus-based classification system of severity associated with IgE-mediated food allergy as a whole disease incorporating multidisciplinary perspectives from different stakeholders involved. RECENT FINDINGS After a systematic review of current evidence on the definition of severity of food allergy, an e-Delphi methodology has been applied to obtain the consensus/agreement through repeated rounds of survey. This comprehensive scoring system has been developed to be used in research settings in its current version with the scope of stratifying the severity of a clinical situation of food allergy. SUMMARY Notwithstanding the limitations due to the complexity of the matter, the recent developed DEFASE definition will be relevant for establishing the levels of diagnostic, management and therapeutic commitment for the disease in the various geographical contexts. Future research should focus on internal and external validation of the scoring system, tailoring of these models to different food allergenic sources, populations, and settings.
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Affiliation(s)
- Stefania Arasi
- Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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Dhanjal R, Dine K, Gerdts J, Merrill K, Frykas TLM, Protudjer JL. An online, peer-mentored food allergy education program improves children's and parents' confidence. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:47. [PMID: 37248523 DOI: 10.1186/s13223-023-00800-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 04/25/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Children with food allergy, and their families experience substantial burdens because of efforts necessary to minimize the risk of anaphylaxis. To this end, peer-to-peer education is paramount. Food Allergy Canada offers an online, peer-to-peer mentoring program. However, the impact of this program has not previously been formally evaluated. OBJECTIVE To determine if Allergy Pals, an online, peer-to-peer mentoring program, for children aged 7-11 years, increased child and parental food allergy competency, and confidence. Our secondary aim was to qualitatively describe the experiences of the program. METHODS From May 2020-May 2021, children and their parents were invited to participate in an online, anonymous survey about Allergy Pals, at pre-program, and post-program. Primary outcomes, which were described and compared using chi2 or t-tests, as appropriate for the respective variables, included food allergy competence (epinephrine carriage, signs and symptoms of anaphylaxis) and food allergy confidence (e.g. comfort asking other for food allergy-related support). Secondary outcomes included child and parent perceptions of the program, which were analysed thematically. RESULTS Overall, 17 children completed the pre-program, and 11 completed the post-program survey. Corresponding numbers for parents were 25 and 23. Food allergy competence was high pre-program, and remained so post-program. Food allergy confidence improved from pre-program to post-program. E.g. Children tended to feel less left out (5/12, 41.7%; 3/10; 30.0%, respectively), a finding that was reflected also in parents' scores. Themes identified for child and parent perceptions further supported improved food allergy confidence. CONCLUSION Although food allergy competence was high pre-program, Allergy Pals improved food allergy confidence.
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Affiliation(s)
| | - Kyle Dine
- Food Allergy Canada, Toronto, ON, Canada
| | | | - Kaitlyn Merrill
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Tara Lynn M Frykas
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Jennifer Lp Protudjer
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, MB, Canada.
- Department of Foods and Human Nutritional Sciences, Faculty of Agriculture and Food Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Pasioti M, Savva M, Lakoumentas J, Kompoti E, Makris M, Xepapadaki P, Papadopoulos NG. Impact of Presumed Tree Nut and Peanut Allergy on Quality of Life at Different Ages. J Clin Med 2023; 12:jcm12103472. [PMID: 37240577 DOI: 10.3390/jcm12103472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/05/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Tree nut and/or peanut allergy impairs patients' quality of life, but data on the impact of age and the type of nut or peanut on the quality of life are lacking. To evaluate the impact at different ages, age-appropriate survey questionnaires accompanied by FAQLQ and FAIM were distributed to patients with suspected tree nut and/or peanut allergy who presented at the allergy departments of three hospitals in Athens. Out of 200 questionnaires distributed, 106 met the inclusion criteria (46 children, 26 teenagers, 34 adults). The median score of each age group for FAQLQ was 4.6 (3.3-5.1), 4.7 (3.9-5.5), and 3.9 (3.2-5.1) and for FAIM was 3.7 (3.0-4.0), 3.4 (2.8-4.0), and 3.2 (2.7-4.1), respectively. FAQLQ and FAIM scores were correlated with the reported probability of using the rescue anaphylaxis set upon reaction (15.4%, p = 0.04 and 17.8%, p = 0.02, respectively) and pistachio allergy (FAQLQ: 4.8 vs. 4.0, p = 0.04; FAIM: 3.5 vs. 3.2, p = 0.03). Patients with additional food allergies reported worse FAQLQ scores (4.6 vs. 3.8, p = 0.05). Worse FAIM scores were associated with younger age (-18.2%, p = 0.01) and the number of life-threatening allergic reactions (25.3%, p < 0.001). The overall impact of tree nut and/or peanut allergy on patients' quality of life is moderate but differs with age, the type of nut, the use of adrenaline, and the number of previous reactions. The aspects of life affected and contributed factors also vary across age groups.
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Affiliation(s)
- Maria Pasioti
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Fidippidou Street, 4th Floor, Goudi, 115 27 Athens, Greece
| | - Maria Savva
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - John Lakoumentas
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - Evangelia Kompoti
- Allergology Department, "Laikon" General Hospital, 115 27 Athens, Greece
| | - Michael Makris
- Allergy Unit 'D. Kalogeromitros', 2nd Department of Dermatology and Venereology, Medical School, National and Kapodistrian University of Athens, University General Hospital "Attikon", 124 62 Chaidari, Greece
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
| | - Nikolaos G Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Athens General Children's Hospital Panagioti and Aglaia Kyriakou, Thivon & Levadias, Ambelokipoi, 115 27 Athens, Greece
- Division of Immunology, Immunity to Infection and Respiratory Medicine, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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Arasi S, Nurmatov U, Dunn-Galvin A, Roberts G, Turner PJ, Shinder SB, Gupta R, Eigenmann P, Nowak-Wegrzyn A, Ansotegui IJ, Rivas MF, Petrou S, Tanno LK, Vazquez-Ortiz M, Vickery B, Wong G, Alvaro-Lozano M, Asaria M, Begin P, Bozzola M, Boyle R, Brough H, Cardona V, Chinthrajah RS, Cianferoni A, Deschildre A, Fleischer D, Gazzani F, Gerdts J, Giannetti M, Greenhawt M, Guzmán MA, Hossny E, Kauppi P, Jones C, Lucidi F, Monge Ortega OP, Munblit D, Muraro A, Pajno G, Podestà M, Rodriguez del Rio P, Said M, Santos A, Shaker M, Szajewska H, Venter C, Warren C, Winders T, Ebisawa M, Fiocchi A. WAO consensus on DEfinition of Food Allergy SEverity (DEFASE). World Allergy Organ J 2023; 16:100753. [PMID: 36910595 PMCID: PMC9996094 DOI: 10.1016/j.waojou.2023.100753] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 01/20/2023] [Accepted: 02/03/2023] [Indexed: 03/06/2023] Open
Abstract
Background While several scoring systems for the severity of anaphylactic reactions have been developed, there is a lack of consensus on definition and categorisation of severity of food allergy disease as a whole. Aim To develop an international consensus on the severity of food allergy (DEfinition of Food Allergy Severity, DEFASE) scoring system, to be used globally. Methods Phase 1 We conducted a mixed-method systematic review (SR) of 11 databases for published and unpublished literature on severity of food allergy management and set up a panel of international experts. Phase 2 Based on our findings in Phase 1, we drafted statements for a two-round modified electronic Delphi (e-Delphi) survey. A purposefully selected multidisciplinary international expert panel on food allergy (n = 60) was identified and sent a structured questionnaire, including a set of statements on different domains of food allergy severity related to symptoms, health-related quality of life, and economic impact. Participants were asked to score their agreement on each statement on a 5-point Likert scale ranging from "strongly agree" to "strongly disagree". Median scores and percentage agreements were calculated. Consensus was defined a priori as being achieved if 70% or more of panel members rated a statement as "strongly agree" to "agree" after the second round. Based on feedback, 2 additional online voting rounds were conducted. Results We received responses from 92% of Delphi panel members in round 1 and 85% in round 2. Consensus was achieved on the overall score and in all of the 5 specific key domains as essential components of the DEFASE score. Conclusions The DEFASE score is the first comprehensive grading of food allergy severity that considers not only the severity of a single reaction, but the whole disease spectrum. An international consensus has been achieved regarding a scoring system for food allergy disease. It offers an evaluation grid, which may help to rate the severity of food allergy. Phase 3 will involve validating the scoring system in research settings, and implementing it in clinical practice.
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Affiliation(s)
- Stefania Arasi
- Allergy Diseases Research Area, Pediatric Allergology Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Ulugbek Nurmatov
- Division of Population Medicine, School of Medicine, Cardiff University, Wales, UK
| | - Audrey Dunn-Galvin
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Graham Roberts
- Faculty of Medicine, University of Southampton, Southampton, UK
- The David Hide Asthma and Allergy Research Centre, St Mary's Hospital, Isle of Wight, UK
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Paul J. Turner
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Sayantani B. Shinder
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Stanford University, Stanford, CA, USA
- Sean N. Parker Center for Allergy and Asthma Research at Stanford University, Stanford University, Stanford, CA, USA
| | - Ruchi Gupta
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Philippe Eigenmann
- Department of Pediatrics, Gynecology and Obstetrics, University Hospital of Geneva, Geneva, Switzerland
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, New York University School of Medicine, Langone Health, New York, NY, USA
- Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
| | - Montserrat Fernandez Rivas
- Allergy Department, Hospital Clinico San Carlos, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford
- Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK
- Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, England, UK
| | - Luciana K. Tanno
- Division of Allergy, Department of Pulmonology, University Hospital of Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UA-11, INSERM University of Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Marta Vazquez-Ortiz
- Section of Inflammation, Repair and Development, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Brian Vickery
- Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Gary Wong
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Montserrat Alvaro-Lozano
- Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Deu, Barcelona, Spain
- Institut de Recerca Sant Joan de Deu, Barcelona, Spain
- Universitat de Barcelona, Spain
| | - Miqdad Asaria
- Department of Health Policy, London School of Economics and Political Science, UK
| | - Philippe Begin
- Allergy, immunology and Rheumatology Division, Department of Pediatrics, CHU Sainte-Justine, Montreal, QC, Canada
- Allergy and Clinical immunology Division, Department of Medicine, Centre Hospitalier de l’Université de Montréal, QC, Canada
| | - Martin Bozzola
- Hospital Britanico de Buenos Aires Buenos Aires, Argentina
| | - Robert Boyle
- National Heart and Lung Institute, Imperial College London, UK
| | - Helen Brough
- Children's Allergy Service, Evelina Children's Hospital, Guy's and St. Thomas' Hospital, London, UK
- Paediatric Allergy Group, Department of Women and Children's Health, School of Life Course Sciences, King's College London, London, UK
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall D’Hebron, Barcelona, Spain
- ARADyAL Research Network, Spain
| | | | - Antonella Cianferoni
- The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA, United States
| | - Antoine Deschildre
- CHU Lille, Univ Lille, Pediatric Allergy and Pulmonology Unit, Hôpital Jeanne de Flandre, 59000 Lille, France
- Section of Pediatric Allergy & Immunology, Children's Hospital Colorado, USA
| | | | - Flavio Gazzani
- Departement of Economics and Law, University of Rome La Sapienza, Italy
| | - Jennifer Gerdts
- Executive Director, Food Allergy Canada, Toronto, Ontario, Canada
| | | | - Matthew Greenhawt
- Section of Allergy and Immunology, Children's Hospital Colorado, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, USA
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Paula Kauppi
- University of Helsinki and Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Carla Jones
- Chief Executive of Patient Organisation, Allergy UK, London, UK
| | - Francesco Lucidi
- Allergology Unit of the San Juan de Dios Hospital, San José, Costa Rica
| | | | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, United Kingdom
- Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - Antonella Muraro
- Food Allergy Centre Department of Woman and Child Health Padua University Hospital, Padua Italy
| | - Giovanni Pajno
- Pediatric Unit- Policlinico Hospital, University of Messina, Messina, Italy
| | | | | | - Maria Said
- CEO Allergy & Anaphylaxis Australia, Sydney, Australia
| | - Alexandra Santos
- Department of Women and Children's Health (Pediatric Allergy), School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Marcus Shaker
- Peter Gorer Department of Immunobiology, School of Immunology and Microbial Sciences, King's College London, London, United Kingdom
- Children's Allergy Service, Evelina London Children's Hospital, Guy's and St Thomas' Hospital, London, United Kingdom
- Asthma UK Centre in Allergic Mechanisms of Asthma, London, United Kingdom
- Dartmouth Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon
| | - Hania Szajewska
- Department of Paediatrics, The Medical University of Warsaw, Warsaw, Poland
| | - Carina Venter
- Section of Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA
| | - Cristopher Warren
- Center for Food Allergy and Asthma Research, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, USA
| | - Tonya Winders
- Allergy & Asthma Network (AAN), President and CEO, Allergy and Asthma Network, Vienna, VA, USA
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization, Sagamihara National Hospital, Sagamihara Japan
| | - Alessandro Fiocchi
- Translational Research in Paediatric Specialities Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Drakouli AE, Kontele I, Poulimeneas D, Saripanagiotou S, Grammatikopoulou MG, Sergentanis TN, Vassilakou T. Food Allergies and Quality of Life among School-Aged Children and Adolescents: A Systematic Review. CHILDREN 2023; 10:children10030433. [PMID: 36979991 PMCID: PMC10047601 DOI: 10.3390/children10030433] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/11/2023] [Accepted: 02/15/2023] [Indexed: 02/25/2023]
Abstract
Recently, besides the focus on the medical diagnosis and therapeutic interventions for food allergy (FA), the psychosocial aspects of this frequent condition have also been investigated. The current systematic review aimed to explore and synthesize the scientific evidence published from January 2015 to April 2022 on Health-Related Quality of Life (HRQoL) among children and adolescents with FAs. Twenty-eight research studies were included in the review, which was conducted on three databases (PubMed, Scopus and Cochrane Library). In most studies, the scores indicate an average level of HRQoL for children and adolescents with FAs, with girls and older children being more negatively affected than boys and younger ones, respectively. Few studies compared HRQoL between children with FA and healthy children, with 3 of them showing worse HRQoL for children with FAs. Immunotherapy has been found to improve the QoL of children with FAs. Anaphylaxis history, number of FAs, additional allergies, number and severity of symptoms were identified as the main factors with a negative impact on QoL. More comparative studies on the HRQoL of children and adolescents with FAs and healthy populations or children with other chronic diseases are required in order to improve QoL of children with FAs.
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Affiliation(s)
- Artemis-Eirini Drakouli
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
| | - Ioanna Kontele
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
| | - Dimitrios Poulimeneas
- Department of Nutrition and Dietetics, University of the Peloponnese, 24100 Kalamata, Greece
- Department of Nutrition and Dietetics, Harokopio University, 17676 Athens, Greece
| | | | - Maria G. Grammatikopoulou
- Unit of Immunonutrition and Clinical Nutrition, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Biopolis, 41110 Larissa, Greece
| | - Theodoros N. Sergentanis
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
- Correspondence: (T.N.S.); (T.V.)
| | - Tonia Vassilakou
- Department of Public Health Policy, School of Public Health, University of West Attica, 196 Alexandras Avenue, 11521 Athens, Greece
- Correspondence: (T.N.S.); (T.V.)
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Ödling M, Andersson N, Janson C, Melén E, Bergström A, Kull I. Health-related quality of life decreases in young people with asthma during the transition from adolescence to young adulthood: a birth cohort study. BMC Pulm Med 2023; 23:34. [PMID: 36694146 PMCID: PMC9872377 DOI: 10.1186/s12890-022-02259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/23/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND During the transition from paediatric to adult healthcare there is a gap between asthma guidelines and actual management with decreased healthcare consultations and dispensations of asthma medications after the transition to adult healthcare among young people with asthma. How health-related quality of life (HRQoL) develops during the transition from adolescence to young adulthood is unclear. Our aim was therefore to investigate HRQoL among young people with asthma during the transition to adulthood. Further, to assess if level of asthma control and physical activity influence any potential association between asthma and HRQoL. METHODS The study population consisted of 2268 participants from the ongoing Swedish population-based prospective birth cohort BAMSE (Barn/Child, Allergy, Milieu, Stockholm, Epidemiology). HRQoL was measured using the instrument EQ-5D-3 L and three general questions. The EQ-5D-3 L consists of the EQ-5D descriptive system and the EQ visual analogue scale (EQ VAS). The EQ-5D-3 L instrument and questions on general health, symptoms and treatment of asthma, and lifestyle factors were based on data from follow-ups at 16 and 24 years. Cross-sectional analyses were made. RESULTS At the 24-year follow-up, the adjusted median values of EQ VAS were lower compared with at the 16-year follow-up; among both participants with asthma (80 vs. 85, p < 0.01) and those without asthma (80 vs. 87, p < 0.01). At the 24-year follow-up, participants with uncontrolled asthma had a lower adjusted median EQ VAS score than peers with controlled/partly controlled asthma (75 vs. 80, p = 0.03). Further, young adults with asthma who did not fulfil the WHO recommendations on physical activity had lower EQ VAS scores than peers who did (70 vs. 80, p < 0.01). CONCLUSION HRQoL is lower in young adulthood than in adolescence. Young adults with asthma having uncontrolled disease or who are physically inactive appear to be particularly vulnerable.
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Affiliation(s)
- Maria Ödling
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Andersson
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Christer Janson
- grid.8993.b0000 0004 1936 9457Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Erik Melén
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.416452.0Sachs’ Children and Youth Hospital, Stockholm, Sweden
| | - Anna Bergström
- grid.4714.60000 0004 1937 0626Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.425979.40000 0001 2326 2191Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Inger Kull
- grid.4714.60000 0004 1937 0626Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden ,grid.416452.0Sachs’ Children and Youth Hospital, Stockholm, Sweden
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9
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Cosyns JC, Frykas TLM, Hildebrand HV, Kim H, Gerdts JD, Abrams EM, Protudjer JL. Peanut, soy, and emerging legume allergy in Canada. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2022; 1:319-321. [PMID: 37779533 PMCID: PMC10509839 DOI: 10.1016/j.jacig.2022.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 04/18/2022] [Accepted: 05/26/2022] [Indexed: 10/03/2023]
Abstract
Background Individuals with 1 legume allergy may be cosensitized to other legumes and thus may potentially have other legume allergies as well. Although the use of emerging legumes (eg, pea, lentils, chickpeas) in commercial food production is increasingly common, the literature has largely focused on peanut and soy, both of which are priority allergens in Canada. Objective We aimed to describe the distribution of priority and emerging legume allergies in Canada, with consideration for patient age. Methods Cross-sectional survey data collected between 2019 and 2021 from families who follow food allergy-related social media platforms were queried for demographics, as well as for food allergy (including by type and number of foods and by age [0-5 vs ≥6 years]). Data were described and then analyzed by using logistic regression and adjusted for sex, age at diagnosis, and number of food allergies. Results Of the 115 participating children, the majority (64.6%) were boys. Nearly all of the children (109 of 115 [94.8%]) had peanut allergy, whereas soy and emerging legume allergies were reported by 15.7% and 13.0% of the children, respectively. Of these 115 children, 85 had mono-peanut allergy, 6 had mono-soy allergy, none had emerging legume allergy in the absence of peanut or soy, 12 had peanut and emerging legume allergy, 9 had peanut and soy allergy, and 3 had peanut, soy, and emerging legume allergy. Compared with children aged 0 to 5 years, children aged 6 years or older were significantly less likely to have peanut plus soy or emerging legume allergy (odds ratio = 0.22 [95% CI = 0.05-0.94]; P = .04). Conclusion Of the children with peanut allergy, a considerable number also had peanut allergy and soy allergy and/or another legume allergy. Younger children have higher odds of multiple legume allergy.
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Affiliation(s)
- Josie C.E. Cosyns
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tara Lynn M. Frykas
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Hailey V. Hildebrand
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Harold Kim
- Canadian Society of Allergy and Clinical Immunology, Orleans, Ontario, Canada
- Division of Clinical Immunology and Allergy, Western University, London, Ontario, Canada
- Division of Clinical Immunology and Allergy, McMaster University, London, Ontario, Canada
| | | | - Elissa M. Abrams
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer L.P. Protudjer
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Canadian Society of Allergy and Clinical Immunology, Orleans, 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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10
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Roche I, Vale SL, Hornung CJ, Zurzolo GA, Netting MJ, Dharmage SC, Gray C, Lee NA, Lacis-Lee J, Jorgensen PF, Smith J, Freeman W, Perrett KP, Voukelatos S, McWilliam VL, Grinter K, Koplin JJ, Said M, Campbell DE. An International First: Stakeholder Consensus Statement for Food Allergen Management in Packaged Foods and Food Service for Australia and New Zealand. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2056-2065. [PMID: 35381394 DOI: 10.1016/j.jaip.2022.03.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 03/14/2022] [Accepted: 03/23/2022] [Indexed: 06/14/2023]
Abstract
Food-allergic consumers encounter inadequate, confusing, and ambiguous allergen information for packaged and unpackaged foods. Key Australian and New Zealand allergy organizations convened multiple forums to facilitate discussions among consumers, food manufacturers, food retailers, regulatory bodies, researchers, and health professionals to develop a unified approach to improving food allergen management. The following stakeholder consensus statement provides a foundation for advocacy for improved food allergen management and safety. It is the responsibility of consumers to: 1. declare their food allergies and read food labels (including ingredient lists and allergen declaration statements), and 2. ultimately make their own judgment about the foods they choose to consume. We consider that to enable consumers to make informed decisions about their safety, It is the responsibility of packaged food manufacturers to: 1. follow robust allergen management practices including quantitative risk assessment, and 2. use clear, consistent labeling to inform consumers about that food's allergen content, including the possible presence of unintended allergens. It is the responsibility of food service establishments and providers to: 1. follow robust allergen management practices, and 2. ensure that staff understand and can inform consumers about the allergen content of the food they provide, including the possible presence of unintended allergens.
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Affiliation(s)
- Ingrid Roche
- Perth Children's Hospital, Perth, Western Australia, Australia; Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Sandra L Vale
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; National Allergy Strategy, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia.
| | - Catherine J Hornung
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Giovanni A Zurzolo
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Merryn J Netting
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia; The University of Adelaide, Adelaide, South Australia, Australia; Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Shyamali C Dharmage
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Nanju A Lee
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; University of New South Wales, Kensington, New South Wales, Australia
| | | | | | - Jill Smith
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia
| | - Wendy Freeman
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; National Allergy Strategy, Sydney, New South Wales, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Kirsten P Perrett
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sally Voukelatos
- National Allergy Strategy, Sydney, New South Wales, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Vicki L McWilliam
- Australasian Society of Clinical Immunology and Allergy, Sydney, New South Wales, Australia; Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | | | - Jennifer J Koplin
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Maria Said
- National Allergy Strategy, Sydney, New South Wales, Australia; The University of Western Australia, Perth, Western Australia, Australia; Allergy and Anaphylaxis Australia, Sydney, New South Wales, Australia
| | - Dianne E Campbell
- Centre for Food and Allergy Research, Melbourne, Victoria, Australia; The Children's Hospital at Westmead, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
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11
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Golding MA, Batac ALR, Gunnarsson NV, Ahlstedt S, Middelveld R, Protudjer JLP. The burden of food allergy on children and teens: A systematic review. Pediatr Allergy Immunol 2022; 33:e13743. [PMID: 35338731 DOI: 10.1111/pai.13743] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 01/24/2022] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Over the last two decades, researchers have placed increasing attention on understanding how food allergy affects the health-related quality of life (HRQL) and psychosocial well-being of children and teens. In response, a number of reviews have been published that aim at synthesizing the literature. However, many of these papers focus narrowly on HRQL or suffer from methodological limitations. METHOD The current review aims to fill this gap by providing a comprehensive overview of the burden of pediatric food allergy by synthesizing the quantitative and qualitative literature. RESULTS Findings from the present review provide evidence of reduced HRQL among children and teens with food allergy, particularly older children and those with more severe manifestations of the condition. In comparison to HRQL, the link between food allergy and psychosocial functioning is less clear; however, some evidence can be cited linking food allergy to greater levels of psychological distress. Qualitative evidence suggests that the burden of pediatric food allergy largely stems from worries surrounding exposures outside of the home and the social consequences of the condition. The current review also highlights several gaps in the literature, including a paucity of longitudinal research, research focused on predictors of psychological distress among children and teens with food allergy as well as a dearth of studies comparing rates of bullying in food-allergic and non-food-allergic samples. CONCLUSION More emphasis should be placed on not only alleviating the social and psychological consequences of food allergy, but also on identifying and assisting those most acutely burdened by the condition.
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Affiliation(s)
- Michael A Golding
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ayel L R Batac
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nina V Gunnarsson
- Department of Social Work, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Roelinde Middelveld
- 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, Manitoba, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada.,Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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12
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Jafri S, Frykas TL, Bingemann T, Phipatanakul W, Bartnikas LM, Protudjer JL. Food Allergy, Eating Disorders and Body Image. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021; 6. [PMID: 36381295 PMCID: PMC9665877 DOI: 10.1016/j.jadr.2021.100197] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background/Introduction: Food allergy (FA) management involves avoiding allergenic foods to prevent an adverse reaction. Affected individuals spend substantial amounts of time thinking about food and the impact it has on their bodies. As such, we posit sustained awareness of food choices may contribute to distorted body image and disordered eating. We performed a narrative review to glean insight into associations between FA, body image and eating disorders. Methods: A literature search of Scopus, PsycINFO, PubMed and Google Scholar was conducted connecting terms for “food allergy” with terms for “body image” and “eating disorders”. Title and abstract screening were independently performed by two reviewers, with relevant abstracts carried forward to full text screening. Results: 159 articles were eligible for full text screening and a total of 12 publications were ultimately included in this narrative review, and 1 article from the grey literature. Adolescents and adults both reported feeling as though their bodies were “defective” and were found to have integrated their FA as a stable facet of their identities. In addition, FA was overwhelmingly associated with prevalence of eating disorders and eating disorder-like symptoms. Disturbed body image was found to be a mediating variable for the development of disordered patterns of eating in food allergic individuals. Limitations: Few studies appeared to consider comorbidities as confounders. Also, many studies employed convenience sampling, which does limit generalizability of conclusions. Discussion/Conclusion: Based on a small body of literature, there appears to be a potential association between FA and distorted body image and disordered eating.
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Affiliation(s)
- Syeda Jafri
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Tara Lynn Frykas
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Theresa Bingemann
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Department of Medicine, and Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, United States
| | - Wanda Phipatanakul
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Division of Immunology, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Lisa M. Bartnikas
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Division of Immunology, Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Jennifer L.P. Protudjer
- Pediatrics and Child Health, University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB, Canada R3E 3P4
- Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada
- Centre for Healthcare Innovation, Winnipeg, MB, Canada
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, The University of Manitoba, Winnipeg, MB, Canada
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Corresponding author: Jennifer L.P. Protudjer, 501G-715 McDermot Ave, Winnipeg, MB, R3E 3P4, Canada, 1 (204) 480 1384, (J.L.P. Protudjer)
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13
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Jonsson M, Ekström S, Protudjer JLP, Bergström A, Kull I. Living with Food Hypersensitivity as an Adolescent Impairs Health Related Quality of Life Irrespective of Disease Severity: Results from a Population-Based Birth Cohort. Nutrients 2021; 13:nu13072357. [PMID: 34371866 PMCID: PMC8308910 DOI: 10.3390/nu13072357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 01/01/2023] Open
Abstract
Food hypersensitivity (FHS) refers to food-related symptoms, with or without concurrent Immunoglobulin E (IgE) antibodies related to food(s). It remains unclear how different FHS phenotypes affect health-related quality of life (HRQoL). We examined self-reported HRQoL (with the generic instrument EQ-5D (dimensions and a Visual Analogue Scale (VAS), range 0–100) in association with phenotypes of FHS, and food-specific symptoms among adolescents (n = 2990) from a population-based birth cohort. Overall, 22% of the adolescents had FHS. Compared to adolescents without FHS, those with FHS reported more problems in the dimensions of pain/discomfort (p < 0.001), and anxiety/depression (p = 0.007). Females with FHS reported more problems than males in these dimensions (p < 0.001). Different FHS phenotypes (IgE-sensitization, allergic co-morbidity, and severity of symptoms) were not associated with differences in HRQoL. EQ-VAS scores were lowest for adolescents with symptoms for wheat vs. no wheat, median 80 vs. 89, p = 0.04) and milk vs. no milk (median 85 vs. 90, p = 0.03). Physician-diagnosed lactose intolerance median EQ-VAS was 80 vs. 90, p = 0.03 and also associated with more problems in the dimension of anxious/depression. In conclusion, FHS is associated with lower HRQoL in adolescence, irrespective of phenotypes, but differentially affects females vs. males, and those with vs. without symptoms for milk or wheat.
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Affiliation(s)
- Marina Jonsson
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.E.); (A.B.)
- Centre for Occupational and Environmental Medicine, Region Stockholm, Solnavägen 4, 113 65 Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden;
- Correspondence:
| | - Sandra Ekström
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.E.); (A.B.)
- Centre for Occupational and Environmental Medicine, Region Stockholm, Solnavägen 4, 113 65 Stockholm, Sweden
| | - Jennifer L. P. Protudjer
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3A 1S1, Canada;
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB R3E 0T6, Canada
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
- The Centre for Allergy Research, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine, Karolinska Institutet, 171 77 Stockholm, Sweden; (S.E.); (A.B.)
- Centre for Occupational and Environmental Medicine, Region Stockholm, Solnavägen 4, 113 65 Stockholm, Sweden
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, 118 83 Stockholm, Sweden;
- Sachs’ Children and Youth Hospital, 118 83 Stockholm, Sweden
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14
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Abrams EM, Kim H, Gerdts J, Protudjer JLP. Milk allergy most burdensome in multi-food allergic children. Pediatr Allergy Immunol 2020; 31:827-834. [PMID: 32413203 DOI: 10.1111/pai.13274] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/08/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Food allergy is a substantial health burden, which disproportionately affects children. Among children with food allergy, as many as 70% have multiple food allergies. Whereas the overall burden of food allergy on quality of life has been described, little is known about the burden of individual allergens. We aimed to examine the perception of burden among families with multiple food-allergic children. METHODS Parents of children with 1 + children with multiple food allergies including milk responded to online questions, including both open-ended and closed-ended questions on food allergy-related burdens of time, financial costs, social restrictions, and emotional demands. RESULTS Overall, 64 children (69.8% boys) of whom (73.0%) most were aged 10 and younger were included. Most had been diagnosed with food allergy in infancy and by a (pediatric) allergist. Other common allergies included peanut (65.6%), tree nuts (57.8%), egg (76.6%), and sesame (31.3%). Quantitatively, milk allergy was reported as carrying the most burden, including most socially limiting (81.5%), requiring the most planning (75.9%), causing the most anxiety (68.5%), most challenging to find "safe" or allergy-friendly foods (72.2%), and costly (81.5%). Qualitatively, we identified five themes that captured burdens associated with costs, marketing of milk products to children, risk of cross-contamination, ubiquity of milk/dairy and public confusion with lactose intolerance, and an unwillingness of others to accommodate the allergy. CONCLUSION Parents whose children have multiple food allergies, including milk, report milk as the allergy associated with the greatest time, financial, social, and emotional burdens.
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Affiliation(s)
- Elissa Michele Abrams
- 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
| | - Harold Kim
- Western University, London, ON, Canada.,McMaster University, Hamilton, ON, Canada
| | | | - Jennifer Lisa Penner Protudjer
- Department of Pediatrics and Child Health, The University of Manitoba, Winnipeg, MB, Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.,The Children's Health Research Institute of Manitoba, Winnipeg, MB, Canada.,Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Centre for Allergy Research, Karolinska Institutet,, Stockholm, Sweden.,Food and Human Nutritional Sciences, The University of Manitoba, Winnipeg, MB, Canada
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15
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Abrams EM, Simons E, Gerdts J, Nazarko O, Povolo B, Protudjer JLP. "I want to really crack this nut": an analysis of parent-perceived policy needs surrounding food allergy. BMC Public Health 2020; 20:1194. [PMID: 32738893 PMCID: PMC7395383 DOI: 10.1186/s12889-020-09309-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background In Canada, anaphylaxis-level food allergy constitutes a legal disability. Yet, no nationwide policies exist to support families. We sought to understand what parents of children with food allergy perceive as the most pressing food allergy-related policy concerns in Canada. Methods Between March–June 2019, we interviewed 23 families whose food allergic children (N = 28mean age 7.9 years) attending an allergy clinic in Winnipeg, Canada. Interviews were audio-recorded, transcribed and analyzed using content analysis. Results Over 40% of children had multiple food allergies, representing most of Health Canada’s priority allergens. We identified four themes: (1) High prevalence. High priority?. (2) Food labels can be misleading, (3) Costs and creative ideas, and (4) Do we have to just deal with the status quo around allergies? Conclusion Food allergy ought to be a national policy priority, to improve the process for precautionary labelling, to improve funding, educational tools access to care, and knowledge of current allergy guidelines.
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Affiliation(s)
- Elissa M Abrams
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Elinor Simons
- Section of Allergy and Immunology, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Orla Nazarko
- Participant Advisory Committee to J Protudjer, Winnipeg, MB, Canada
| | - Beatrice Povolo
- Advocacy and Media Relations, Food Allergy Canada, Toronto, ON, Canada
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16
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Vazquez‐Ortiz M, Angier E, Blumchen K, Comberiati P, Duca B, DunnGalvin A, Gore C, Hox V, Jensen B, Pite H, Santos AF, Sanchez S, Alviani C, Garriga‐Baraut T, Knibb R, Mortz CG, Gowland MH, Timmermans F, Roberts G. Understanding the challenges faced by adolescents and young adults with allergic conditions: A systematic review. Allergy 2020; 75:1850-1880. [PMID: 32141620 DOI: 10.1111/all.14258] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/26/2020] [Accepted: 02/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Adolescence represents a vulnerable time for individuals with asthma and allergic conditions. They suffer an unexpected degree of morbidity. This systematic review aimed to understand the challenges faced by adolescents and young adults with these conditions. METHODS A systematic literature search was undertaken across eight databases. References were checked by two reviewers for inclusion. Study data were extracted, and their quality was assessed in duplicate. A narrative meta-synthesis was undertaken. RESULTS A total of 108 papers describing 106 studies were retrieved, most focused on asthma. Five themes were identified across studies: (a) Health-related quality of life-impairment was associated with poor disease control, psychosocial issues, adolescent-onset allergic disease and female sex; (b) Psychological factors-asthma and food allergy were associated with anxiety and depression, atopic dermatitis was associated with suicidal ideation, and that parental emotional support may be protective; (c) Adherence-suboptimal adherence was associated with older age, barriers to medication usage, poor symptom perception and failure to take responsibility, and positive factors were routines, simpler treatment regimes, better knowledge and perceptions about medications; (d) Self-management-facilitated by education, knowledge and a positive attitude; and (e) Supportive relationships-families could modify barriers to adherence and foster positive views about self-management, adolescents suggested that their peers should be more involved in supporting them, and adolescents also wished to have support from nonjudgemental healthcare professionals. CONCLUSIONS We have some understanding of the challenges faced by adolescents with asthma, less so for other allergic conditions. This knowledge will be used to support guidelines for managing adolescents.
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Affiliation(s)
- Marta Vazquez‐Ortiz
- Department of Paediatrics Faculty of Medicine Imperial College London London UK
| | - Elizabeth Angier
- Primary Care and Population Sciences University of Southampton Southampton UK
| | - Katharina Blumchen
- Department of Paediatric and Adolescent Medicine Paediatric Pneumology Allergology and Cystic Fibrosis University Hospital Frankfurt Frankfurt am Main Germany
| | - Pasquale Comberiati
- Section of Paediatrics Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
- Department of Clinical Immunology and Allergology I.M. Sechenov First Moscow State Medical University Moscow Russia
| | - Bettina Duca
- Department of Paediatrics Imperial College London London UK
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health University College Cork Cork Ireland
- Paediatrics and Child Infectious Diseases First Moscow State Medical University Moscow Russia
| | - Claudia Gore
- Department of Paediatrics Imperial College London London UK
- Department of Paediatrics Imperial College Healthcare NHS Trust London UK
| | - Valérie Hox
- Department of Otorhinolaryngology Head and Neck Surgery University Hospitals Saint‐Luc Brussels Belgium
| | - Britt Jensen
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | - Helena Pite
- Allergy Center CUF Descobertas Hospital and CUF Infante Santo Hospital Lisbon Portugal
- CEDOC Chronic Diseases Research Center NOVA Medical School/Faculdade de Ciências Médicas Universidade Nova de Lisboa Lisbon Portugal
| | - Alexandra F. Santos
- Department of Women and Children’s Health (Paediatric Allergy) Faculty of Life Sciences and Medicine School of Life Course Sciences King’s College London London UK
- Peter Gorer Department of Immunobiology School of Immunology and Microbial Sciences King’s College London London UK
- Children’s Allergy Service Guy’s and St Thomas’ Hospital London UK
- Asthma UK Centre in Allergic Mechanisms of Asthma London UK
| | - Silvia Sanchez
- Allergy Department Hospital Infantil Universitario del Niño Jesús Madrid Spain
| | - Cherry Alviani
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
| | - Teresa Garriga‐Baraut
- Unitat d'Al.lergologia Pediàtrica Hospital Universitari Vall d'Hebron Barcelona Spain
- Grup d’Investigació “Creixement i Desenvolupament” Institut de Recerca de l’Hospital Universitari Vall d’Hebron (VHIR) Barcelona Spain
| | - Rebecca Knibb
- Department of Psychology School of Life and Health Sciences Aston University Birmingham UK
| | - Charlotte G. Mortz
- Department of Dermatology and Allergy Centre Odense Research Centre for Anaphylaxis (ORCA) Odense University Hospital University of Southern Denmark Odense Denmark
| | | | - Frans Timmermans
- Frans Timmermans: Nederlands Anafylaxis Netwerk – European Anaphylaxis Taskforce Dordrecht The Netherlands
| | - Graham Roberts
- University of Southampton Faculty of Medicine Southampton UK
- The David Hide Asthma and Allergy Research Centre St Mary’s Hospital Isle of Wight UK
- NIHR Southampton Biomedical Research Centre University Hospital Southampton NHS Foundation Trust Southampton UK
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Protudjer JLP, Soller L, Abrams EM, Chan ES. Billing fees for various common allergy tests vary widely across Canada. Allergy Asthma Clin Immunol 2020; 16:28. [PMID: 32336976 PMCID: PMC7178720 DOI: 10.1186/s13223-020-00426-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/13/2020] [Indexed: 11/15/2022] Open
Abstract
Background The prevalence of food allergy in Canada is high and has increased over time. To date, there are no Canadian data on the healthcare costs of visits to allergists. Methods We sent an anonymous survey to allergist members of the Canadian Society of Allergy and Clinical Immunology (CSACI) between October and December 2019. Survey questions included demographic information and billing fees for various types of allergy visits and diagnostic testing. Results Of 200 allergists who are members of CSACI, 43 allergists responded (21.5% response rate). Billing fees varied widely. The greatest ranges were noted for oral immunotherapy (OIT; both initial consultation [mean $198.70; range $0 to $575] and follow up/build up visits [mean $125.74; range: $0 to $575]). There were significant provincial differences in billing fees, as well as significant billing fee differences between hospital versus community allergists (e.g. oral food challenge [OFC]: $256.38 vs. $134.94, p < 0.01). Billing fees were higher outside of Ontario, with the exception of specific Immunoglubulin E (sIgE) testing and OIT visits. Conclusions Greater standardization of billing fees across provinces and between hospital versus community allergy could result in more consistency of billing fees for OFC and OIT across Canada. Further knowledge of exact costs will help inform practice and policy in the diagnosis and management of food allergy.
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Affiliation(s)
- Jennifer Lisa Penner Protudjer
- 1Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.,The Children's Health Research Institute of Manitoba, Winnipeg, Canada.,4Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,5Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden.,6Food and Human Nutritional Sciences, The University of Manitoba, Winnipeg, Canada
| | - Lianne Soller
- 7Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC Canada.,8BC Children's Hospital Research Institute, Vancouver, BC Canada
| | - Elissa Michelle Abrams
- 1Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada.,7Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC Canada
| | - Edmond S Chan
- 7Division of Allergy & Immunology, Department of Pediatrics, Faculty of Medicine, The University of British Columbia, Vancouver, BC Canada.,8BC Children's Hospital Research Institute, Vancouver, BC Canada
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18
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Bégin P, Chan ES, Kim H, Wagner M, Cellier MS, Favron-Godbout C, Abrams EM, Ben-Shoshan M, Cameron SB, Carr S, Fischer D, Haynes A, Kapur S, Primeau MN, Upton J, Vander Leek TK, Goetghebeur MM. CSACI guidelines for the ethical, evidence-based and patient-oriented clinical practice of oral immunotherapy in IgE-mediated food allergy. Allergy Asthma Clin Immunol 2020; 16:20. [PMID: 32206067 PMCID: PMC7079444 DOI: 10.1186/s13223-020-0413-7] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 02/14/2020] [Indexed: 12/17/2022] Open
Abstract
Background Oral immunotherapy (OIT) is an emerging approach to the treatment of patients with IgE-mediated food allergy and is in the process of transitioning to clinical practice. Objective To develop patient-oriented clinical practice guidelines on oral immunotherapy based on evidence and ethical imperatives for the provision of safe and efficient food allergy management. Materials and methods Recommendations were developed using a reflective patient-centered multicriteria approach including 22 criteria organized in five dimensions (clinical, populational, economic, organizational and sociopolitical). Data was obtained from: (1) a review of scientific and ethic literature; (2) consultations of allergists, other healthcare professionals (pediatricians, family physicians, nurses, registered dieticians, psychologists, peer supporters), patients and caregivers; and patient associations through structured consultative panels, interviews and on-line questionnaire; and (3) organizational and economic data from the milieu of care. All data was synthesized by criteria in a multicriteria deliberative guide that served as a platform for structured discussion and development of recommendations for each dimension, based on evidence, ethical imperatives and other considerations. Results The deliberative grid included 162 articles from the literature and media reviews and data from consultations involving 85 individuals. Thirty-eight (38) recommendations were made for the practice of oral immunotherapy for the treatment of IgE mediated food allergy, based on evidence and a diversity of ethical imperatives. All recommendations were aimed at fostering a context conducive to achieving objectives identified by patients and caregivers with food allergy. Notably, specific recommendations were developed to promote a culture of shared responsibility between patients and healthcare system, equity in access, patient empowerment, shared decision making and personalization of OIT protocols to reflect patients' needs. It also provides recommendations to optimize organization of care to generate capacity to meet demand according to patient choice, e.g. OIT or avoidance. These recommendations were made acknowledging the necessity of ensuring sustainability of the clinical offer in light of various economic considerations. Conclusions This innovative CPG methodology was guided by patients' perspectives, clinical evidence as well as ethical and other rationales. This allowed for the creation of a broad set of recommendations that chart optimal clinical practice and define the conditions required to bring about changes to food allergy care that will be sustainable, equitable and conducive to the well-being of all patients in need.
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Affiliation(s)
- P Bégin
- 1Division of Clinical Immunology, Rheumatology and Allergy, Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, QC Canada.,2Division of Allergy and Clinical Immunology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC Canada.,3Research Center of the Sainte-Justine University Hospital Center, Montreal, QC Canada
| | - E S Chan
- 4Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC Canada
| | - H Kim
- 5Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada.,6Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON Canada
| | - M Wagner
- 7Unit Methods, Ethics and Participation, INESSS, National Institute for Excellence in Health and Social Services, Montreal, QC Canada
| | - M S Cellier
- 3Research Center of the Sainte-Justine University Hospital Center, Montreal, QC Canada
| | - C Favron-Godbout
- 8Department of Bioethics, School of Public Health of the University of Montreal, Montreal, Canada
| | - E M Abrams
- 9Section of Allergy and Clinical Immunology, Department of Pediatrics, University of Manitoba, Winnipeg, MB Canada
| | - M Ben-Shoshan
- 10Division of Allergy Immunology and Dermatology, Department of Pediatrics, Montreal Children's Hospital, Montreal, QC Canada
| | - S B Cameron
- 4Division of Allergy & Immunology, Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, BC Canada.,Community Allergy Clinic, Victoria, BC Canada
| | - S Carr
- 12Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - D Fischer
- 5Division of Clinical Immunology and Allergy, Department of Medicine, Western University, London, ON Canada
| | - A Haynes
- 13Discipline of Pediatrics, Memorial University of Newfoundland, St. John's, NL Canada
| | - S Kapur
- 14Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - M N Primeau
- 15Division of Allergy and Clinical Immunology, Department of Medicine, CISSS Laval, Laval, QC Canada
| | - J Upton
- 16Division of Immunology and Allergy, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON Canada
| | - T K Vander Leek
- 12Department of Pediatrics, University of Alberta, Edmonton, AB Canada
| | - M M Goetghebeur
- 7Unit Methods, Ethics and Participation, INESSS, National Institute for Excellence in Health and Social Services, Montreal, QC Canada
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19
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Abrams EM, Simons E, Roos L, Hurst K, Protudjer JLP. Qualitative analysis of perceived impacts on childhood food allergy on caregiver mental health and lifestyle. Ann Allergy Asthma Immunol 2020; 124:594-599. [PMID: 32145318 DOI: 10.1016/j.anai.2020.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/09/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Approximately 8% of children have food allergy. Yet, little is known about how parents cope with the burden of this disease. OBJECTIVE This study aimed to describe the perceptions of food allergy-related mental health issues of parents of children with food allergy. METHODS Parents of children with pediatric allergist-diagnosed food allergy were recruited through allergy clinics and education centers in a large Canadian city. We used content analysis to identify overarching themes. RESULTS We interviewed 21 parents with children (boys [13/21; 62.9%]) aged younger than 12 months to 16 years. Interviews averaged 47 (range 33-82) minutes. Most children were diagnosed as infants, and few (7/21; 33.3%) were monoallergic. About one-half (7/16; 43.8%) had a history of anaphylaxis. Parents of children with a single food allergy spoke of "accommodation and adaptation." In contrast, parents of children with multiple food allergies described "anxiety and isolation" and spoke of being "depressed" and "terrified" about leaving their children in the care of others who may not be equipped to handle food allergy. Many parents felt "overwhelmed and alone," especially if they lacked support from extended family and/or their social circle. "Fear for today, fear for the future" was commonly described by parents, although a tenuous symbiotic coexistence was developed, with parents stating "Food allergy management has become our normal." Finally, a small group of parents reported that "Bullying happens, but we are alone to cope with it." CONCLUSION Multiple food allergies negatively affect the mental health of parents, in a variety of well-being domains.
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Affiliation(s)
- Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; Meadowood Medical Centre, Winnipeg, Canada; Department of Pediatrics, Section of Allergy and Clinical Immunology, University of British Columbia, Vancouver, Canada
| | - Elinor Simons
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Leslie Roos
- Deparment of Psychology, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Kim Hurst
- Faculty of Arts and Sciences (Life Sciences), Queen's University, Kingston, Canada
| | - Jennifer L P Protudjer
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Canada; George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, Canada.
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20
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Protudjer JLP, Middelveld R, Dahlén SE, Ahlstedt S. Food allergy-related concerns during the transition to self-management. Allergy Asthma Clin Immunol 2019; 15:54. [PMID: 31507642 PMCID: PMC6727333 DOI: 10.1186/s13223-019-0370-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/28/2019] [Indexed: 01/02/2023] Open
Abstract
Background Compared to non-allergic individuals, food allergic individuals have impaired health-related quality of life (HRQL). However, effects of gender and age are unclear. The objective of our study was to describe associations between allergies to common foods and HRQL with consideration to gender and age. Methods Adolescents and adults (N = 137; 49.6% males) with specialist-diagnosed allergy to milk, egg and/or wheat completed age-appropriate versions of the Food Allergy Quality of Life Questionnaire (FAQLQ). We pooled common questions and calculated overall- and domain-specific HRQL in association with number and severity of symptoms and time elapse since worst reaction. Results In the entire study population, HRQL was not affected by gender or age, whereas gender-specific age categories affected HRQL among males only. For example, males 18–39 years had worse overall- (β = 0.77; 95% CI 0.08–1.45) and domain-specific HRQL vs. males < 18 years. Among participants with 1–3 food allergy symptoms, no associations were found. Among participants with 4–6 symptoms, the domain allergen avoidance and dietary restrictions was worse among older participants (e.g. 40+ years: β = 0.71; 95% CI 0.05–1.37 vs. < 18 years), and males 18–39 vs. < 18 years. Among participants with severe symptoms, females vs. males, and participants 18–39 vs. < 18 years had worse HRQL. At least 4 years since worst reaction was associated with worse HRQL for participants 40+ years vs. < 18 years, and older males vs. males < 18 years. Nearly all differences exceeded the clinical relevance threshold of ≥ 0.5. Conclusions Associations between allergies to common foods and HRQL are affected by gender and age. Most affected are males 18–39 years. Among females, HRQL is more stable across age groups.
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Affiliation(s)
- Jennifer Lisa Penner Protudjer
- 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,2Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.,4The Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Roelinde Middelveld
- 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,5The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Sven-Erik Dahlén
- 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,5The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Staffan Ahlstedt
- 1Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,5The Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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21
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Thörnqvist V, Middelveld R, Wai HM, Ballardini N, Nilsson E, Strömquist J, Ahlstedt S, Nilsson LJ, Protudjer JLP. Health-related quality of life worsens by school age amongst children with food allergy. Clin Transl Allergy 2019; 9:10. [PMID: 30774928 PMCID: PMC6366088 DOI: 10.1186/s13601-019-0244-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 01/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Food allergy is negatively associated with health-related quality of life (HRQL). Although differences exist between parents and children, less is known about age-specific differences amongst children. As such, we aimed to identify if age, as well as other factors, are associated with food allergy-specific HRQL in an objectively defined population of children. Methods Overall, 63 children (boys: n = 36; 57.1%) with specialist-diagnosed food allergy to 1 + foods were included. Parents/guardians completed the Swedish version of a disease-specific questionnaire designed to assess overall- and domain-specific HRQL. Descriptive statistics and linear regression were used. Results The most common food allergy was hen’s egg (n = 40/63; 63.5%). Most children had more than one food allergy (n = 48; 76.2%). Nearly all had experienced mild symptoms (e.g. skin; n = 56/63; 94.9%), and more than half had severe symptoms (e.g. respiratory; 39/63; 66.1%). Compared to young children (0–5 years), older children (6–12 years) had worse HRQL (e.g. overall HRQL: B = 0.60; 95% CI 0.05–1.16; p < 0.04.). Similarly, multiple food allergies, and severe symptoms were significantly associated with worse HRQL (all p < 0.05) even in models adjusted for concomitant allergic disease. No associations were found for gender or socioeconomic status. Conclusion Older children and those with severe food allergy have worse HRQL. Electronic supplementary material The online version of this article (10.1186/s13601-019-0244-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Victoria Thörnqvist
- 1The Centre for Allergy Research, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden.,2The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Roelinde Middelveld
- 1The Centre for Allergy Research, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden.,2The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Hay Mar Wai
- 1The Centre for Allergy Research, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden.,2The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Natalia Ballardini
- 2The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,3Sachs' Children and Youth Hospital, Sodersjukhuset, Stockholm, Sweden
| | - Evalill Nilsson
- 5Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Staffan Ahlstedt
- 1The Centre for Allergy Research, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden.,2The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Jennifer L P Protudjer
- 1The Centre for Allergy Research, Karolinska Institutet, Box 210, 171 77 Stockholm, Sweden.,2The Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,6Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada.,George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Canada.,The Children's Health Research Institute of Manitoba, Winnipeg, Canada
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22
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Barnett J, Begen FM, Gowland MH, Lucas JS. Comparing the eating out experiences of consumers seeking to avoid different food allergens. BMC Public Health 2018; 18:1263. [PMID: 30442121 PMCID: PMC6238278 DOI: 10.1186/s12889-018-6117-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/12/2018] [Indexed: 01/13/2023] Open
Abstract
Background Eating outside the home is challenging for consumers with food allergy (FA) and intolerance (FI) and lack of allergen information provision in eating out venues can lead to unnecessary restrictions. Following European legislation (2014) designed to improve allergen information provision, little is known about differences in information provision experienced by consumers seeking to avoid particular allergens, or how this impacts on their eating out experiences. This study compared the information provision that consumers with FA/FI to different allergens experience when eating out. Methods Using mixed methods, participants were recruited from across the UK and took part in self-report surveys or in-depth interviews. Surveys were completed by 232 participants avoiding either gluten (n = 66), nuts (peanuts/tree nuts) (n = 94), or milk (n = 74), and responses were subject to quantitative analyses. Interviews were carried out with 49 participants avoiding either gluten (n = 13), nuts (n = 14), milk (n = 13) or a combination of these allergens (n = 9), and analysed using the framework approach. Results Although general improvements in information provision following the legislation were reported, variations in provision between allergen groups led participants seeking to avoid milk to conclude that their dietary needs were less well-understood and seen as less important. These perceptions were reflected in a reluctance to involve eating out venue staff in deliberations about the potential for milk-free meal options. Conclusions The provision of visual indicators of the presence of milk and of staff trained in allergen-awareness would improve the eating out experiences of consumers seeking to avoid milk. Medical professions can play a key role in encouraging these patients to pursue their right to make enquiries about allergens in order to avoid accidental milk ingestion when eating out. Electronic supplementary material The online version of this article (10.1186/s12889-018-6117-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julie Barnett
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Fiona M Begen
- Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | | | - Jane S Lucas
- Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Vasconcelos MJ, Delgado L, Silva D. Food-Dependent Exercise-Induced Anaphylaxis. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0171-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Arik Yilmaz E, Cavkaytar O, Buyuktiryaki B, Soyer O, Sahiner UM, Sekerel BE, DunnGalvin A, Karabulut E, Sackesen C. Factors Affecting Food Allergy-Related Quality of Life From Parents' Perception in Turkish Children. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2018; 10:379-386. [PMID: 29949834 PMCID: PMC6021590 DOI: 10.4168/aair.2018.10.4.379] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/16/2018] [Accepted: 04/18/2018] [Indexed: 01/06/2023]
Abstract
Purpose Food allergy (FA) affects the daily lives of children and parents in varying degrees. The Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) is a valid and reliable instrument to assess the quality of life (QoL) of children from parents' perception. The aim of this study was to validate and determine the reliability of the Turkish FAQLQ-PF and to assess QoL in food-allergic children. Methods Children aged between 0 and 12 years and diagnosed with immunoglobulin E (IgE)-mediated FA for at least 1 month were enrolled. The English FAQLQ-PF was translated into Turkish according to the World Health Organization guidelines. The Food Allergy Independent Measure and the Turkish Child Health Questionnaire-Parent Form 50 were used for construct validity. Results One hundred and fifty-seven patients participated. The median age of patients and FA duration were 2.4 years (1.2–5.2 years, interquartile-ranges) and 2 years (0.8–5.1), respectively. Ninety-six (61.1%) patients had anaphylaxis. The Cronbach's alpha coefficient and intra-class correlation coefficient for test-retest reliability was good for all age groups of children (<4, 4–6, and 7–12 years). Patients with either asthma or anaphylaxis had worse scores than others. Total scores of FAQLQ-PF tended to increase with age. Patients aged 7–12 had the highest total scores among all patients (2.2±0.1, 3.0±0.2, and 3.3±0.3 for <4, 4–6, and 7–12 years, respectively, P<0.001, P for trend <0.001). Other factors causing the poor QoL were cow's milk allergy, sibling allergy, mother's age over 30 years, mother's high education level and lower number of persons in household. Conclusions The Turkish FAQLQ-PF is a valid and reliable scale. FA-related QoL was significantly worse with age. Coexistent asthma, anaphylaxis regardless of its severity, cow's milk allergy, sibling allergy and the older and educated mothers seem to poorly affect QoL.
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Affiliation(s)
- Ebru Arik Yilmaz
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozlem Cavkaytar
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Betul Buyuktiryaki
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Ozge Soyer
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Umit M Sahiner
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Bulent E Sekerel
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey
| | - Audrey DunnGalvin
- Department of Paediatrics and Child Health, Cork University Hospital, Wilton, Cork, Ireland
| | - Erdem Karabulut
- Department of Statistics, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cansin Sackesen
- Department of Pediatric Allergy, Hacettepe University School of Medicine, Ankara, Turkey.,Department of Pediatric Allergy, Koc University School of Medicine, Istanbul, Turkey.
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25
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Wahn U, Matricardi PM, Bieber T, Bousquet J, Grattan C, Simon HU, Muraro A, Agache I. Food allergy in EAACI journals (2016). Pediatr Allergy Immunol 2017; 28:825-830. [PMID: 29067711 DOI: 10.1111/pai.12830] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 01/26/2023]
Abstract
Over the last years we have observed considerable progress in the area of food allergy, particularly in children. This review article focusses on important contributions which have lately been published in the three journals of the European Academy of Allergy and Clinical Immunology. A better understanding of allergens as well as the mechanisms of sensitization and tolerance induction may hopefully lead to a more targeted management of food allergy in the near future.
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Affiliation(s)
- Ulrich Wahn
- Department of Pediatric Pneumology and Immunology, Charité, Berlin, Germany
| | - Paolo M Matricardi
- AG Molecular Allergology and Immunomodulation, Department of Pediatric Pneumology and Immunology, Charité Medical University, Berlin, Germany
| | - Thomas Bieber
- Department of Dermatology and Allergy, Rheinische Friedrich-Wilhelms-University Bonn, Bonn, Germany
| | - Jean Bousquet
- MACVIA-France, Contre les MAladies Chroniques pour un VIeillissement Actif en France European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France.,INSERM U 1168, VIMA: Ageing and chronic diseases Epidemiological and public health approaches Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France.,Euforea, Brussels, Belgium
| | - Clive Grattan
- Dermatology Centre, Norfolk& Norwich University Hospital, Norwich, UK
| | - Hans-Uwe Simon
- Institute of Pharmacology, University of Bern, Bern, Switzerland
| | - Antonella Muraro
- Department of Women and Child Health, Food Allergy Referral Centre Veneto Region, Padua General University Hospital, Padua, Italy
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
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26
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Strinnholm Å, Hedman L, Winberg A, Jansson SA, Lindh V, Rönmark E. Health Related Quality of Life among schoolchildren aged 12-13 years in relation to food hypersensitivity phenotypes: a population-based study. Clin Transl Allergy 2017; 7:20. [PMID: 28680560 PMCID: PMC5494861 DOI: 10.1186/s13601-017-0156-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/31/2017] [Indexed: 11/24/2022] Open
Abstract
Background While Health Related Quality of Life has been investigated among children with IgE-mediated food allergy, less is known about quality of life among children with other types of hypersensitivity to food. The aim of this study was to investigate Health Related Quality of Life (HRQL) in children with and without food hypersensitivity. Further, we compared HRQL between children with different phenotypes of food hypersensitivity.
Methods In a large population-based cohort of schoolchildren in Northern Sweden, the parents of 2612 (96% of invited) completed a questionnaire. All 125 (5%) children who reported complete elimination of milk, egg, fish or wheat due to food hypersensitivity were invited to a clinical examination and 94 children participated. Of these, 75 children also completed a generic (KIDSCREEN-52) and a disease-specific HRQL questionnaire (FAQLQ-TF). Thereafter, these children were categorised into the different phenotypes: current food allergy, outgrown food allergy, and lactose intolerance. Additionally, 209 children with unrestricted diets answered the generic questionnaire.
Results The median score of all KIDSCREEN-52 domains were above the population norm of 50 both in children with and without food hypersensitivity. No significant differences in distribution in generic or disease-specific HRQL were found between children with or without food hypersensitivity. There were no significant differences in HRQL between children with different phenotypes of food hypersensitivity. However, children with current food allergy tended to have the lowest HRQL. Further, poor HRQL defined as ≥75th percentile for the disease specific score was significantly more common in the current food allergy phenotype in the domain Emotional impact and the total FAQLQ, compared to the other phenotypes. Conclusions In this population-based study, 12–13 year old children reported good HRQL regardless of having food hypersensitivity or not. However, the children with the current phenotype reported lower HRQL than the other phenotypes. Electronic supplementary material The online version of this article (doi:10.1186/s13601-017-0156-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Åsa Strinnholm
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, OLIN Unit, Umeå University, 901 87 Umeå, Sweden.,Department of Nursing, Umeå University, 901 87 Umeå, Sweden
| | - Linnéa Hedman
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, OLIN Unit, Umeå University, 901 87 Umeå, Sweden.,Division of Nursing, Department of Health Sciences, Luleå University of Technology, 971 87 Luleå, Sweden
| | - Anna Winberg
- Department of Clinical Sciences, Pediatrics, Umeå University, 901 87 Umeå, Sweden
| | - Sven-Arne Jansson
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, OLIN Unit, Umeå University, 901 87 Umeå, Sweden
| | - Viveca Lindh
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden
| | - Eva Rönmark
- Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, OLIN Unit, Umeå University, 901 87 Umeå, Sweden
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27
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Majowicz SE, Jung JKH, Courtney SM, Harrington DW. Exploring the Concern about Food Allergies among Secondary School and University Students in Ontario, Canada: A Descriptive Analysis. J Allergy (Cairo) 2017; 2017:2051916. [PMID: 28592973 PMCID: PMC5448059 DOI: 10.1155/2017/2051916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/16/2017] [Indexed: 11/18/2022] Open
Abstract
Our objective was to explore the perceived risk of food allergies among students in Ontario, Canada. We analyzed blinding questions ("I am concerned about food allergies"; "food allergies are currently a big threat to my health") from three existing food safety surveys, given to high school and university undergraduate students (n = 3,451) circa February 2015, using descriptive analysis, and explored how concern related to demographics and self-reported cooking ability using linear regression. Overall, high school students were neutral in their concern, although Food and Nutrition students specifically were significantly less concerned (p = 0.002) than high school students overall. University undergraduates were moderately unconcerned about food allergies. Concern was highest in younger students, decreasing between 13 and 18 years of age and plateauing between 19 and 23 years. Among students aged 13-18 years, concern was higher among those who worked or volunteered in a daycare and who had previously taken a food preparation course. Among students aged 19-23 years, concern was higher among females and those with less advanced cooking abilities. Concern was significantly correlated with perceiving food allergies as a personal threat. This study offers a first exploration of perceived risk of food allergies among this demographic and can guide future, more rigorous assessments.
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Affiliation(s)
- Shannon E. Majowicz
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON, Canada N2L 3G1
| | - James K. H. Jung
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON, Canada N2L 3G1
| | - Sarah M. Courtney
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON, Canada N2L 3G1
| | - Daniel W. Harrington
- School of Public Health and Health Systems, University of Waterloo, 200 University Ave. West, Waterloo, ON, Canada N2L 3G1
- Public Health Ontario, Suite 300, 480 University Avenue, Toronto, ON, Canada M5G 1V2
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28
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Protudjer JLP, Vetander M, Kull I, Hedlin G, van Hage M, Wickman M, Bergström A. Food-Related Symptoms and Food Allergy in Swedish Children from Early Life to Adolescence. PLoS One 2016; 11:e0166347. [PMID: 27846286 PMCID: PMC5112902 DOI: 10.1371/journal.pone.0166347] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/27/2016] [Indexed: 12/03/2022] Open
Abstract
Background Risk factors for persistence of food-related symptoms (FRS) and food allergy (FA) from early life to adolescence are incompletely understood. The aim of this study was to identify risk factors for FRS and FA in adolescence amongst children with FRS or FA in the first four years of life (early life). Methods In children enrolled in a Swedish birth cohort and followed to 16 years (n = 2572), we defined children with early life FRS in the absence of FA, and FA. Corresponding phenotypes were defined at 16 years. Associations between potential risk factors at 4 years and FRS and FA at 16 years were investigated using logistic regression. Results Early life FRS and FA prevalences were 12.2% and 6.8%, respectively. Amongst children with early life FRS, 35.7% had FRS or FA at 16 years, whereas 74.3% of the children with early life FA had FA at 16 years. For each of the early life phenotypes, parental allergy, early life allergic multimorbidity, early life reactions to peanuts/tree nuts and IgE reactivity at 4 years were statistically significantly associated with FRS or FA at 16 years. In contrast, male sex was associated with an increased risk of FA at 16 years among children with early life FA only. Conclusions In early life, food-related symptoms are twice as common as food allergy. Unlike food allergy, food-related symptoms often remit by adolescence. Yet, these phenotypes have many common risk factors for persistence to adolescence.
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Affiliation(s)
- Jennifer L. P. Protudjer
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Mirja Vetander
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Inger Kull
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Hedlin
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s and Children’s Health and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Marianne van Hage
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Department of Medicine Solna, Immunology and Allergy Unit, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Wickman
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Sachs’ Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Anna Bergström
- Institute of Environmental Medicine and Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
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