Quality of Life in Food Allergic Children: Results From 174 Quality-Of-Life Patient Questionnaires

The authors investigated the effect of food allergy on quality of life (FAQoL), factors associated with worse FAQoL, and the differences in FAQoL between adolescents versus younger children with food allergy.

Children aged 0 to 17 years with a food allergy were recruited from the Allergy Clinic at Texas Children’s Hospital from June 2017–June 2019. 150 children (aged 0–12) and 24 adolescents (13–17) participated. Patients who had outgrown their food allergy were excluded. Eighty-eight percent of children and 95.8% of adolescents were peanut allergic. Forty-seven percent of children and 79.2% of adolescents had experienced anaphylaxis.

Parents completed the food allergy quality of life questionnaire (FAQLQ)-Parent form as a proxy for children 0–12 years. Adolescents, age 13 to 17 years, completed the FAQLQ-teenager form. The FAQLQs use a 7-point Likert scale and higher scores reflect worse QoL. The FAQLQs measure an overall and domain specific score. Domains include emotional impact (EI), food anxiety (FA), and social and dietary limitations (SDL). Respondents also completed the Food Allergy Independent Measure, an instrument that measures concern about unintentional exposure and severity. The authors summarized patient characteristics and scores, which they then stratified by age. Comparisons were made for QoL scores, demographics, anaphylaxis and epinephrine use and allergic reaction symptoms.

EI (3.8 vs 3.1, P = .02), SDL (5.2 vs 4, P = .002) and the overall FAQLQ score (4.7 vs 3.5, P = .007) were significantly higher (worse FAQoL) in adolescents as compared with children. The median FAQLQ score increased by 0.12 points (95% CI, 0.07–0.17) per year increase in age. The EI score increased by 0.09 points (95% CI, 0.05–0.13), the FA score increased 0.18 points (95% CI, 0.12–0.26) (for children) and the SDL score increased 0.09 points (95% CI, 0.03–0.14) per year increase in age. The overall FAQLQ score was 1.65 points higher (95% CI, 0.67–2.63) for those who reported food allergy limited family activities a lot as compared with those who did not report limitation, the EI score was 1.83 points higher (95% CI, 1.04–2.62), and the SDL was 3.06 points higher (95% CI, 2.56–3.55). The FA score was 1.91 points lower (95% CI, −2.94 to −0.88) among those whose family activities were not limited as compared with those whose activities were limited a lot. Compared with younger children, more adolescents had previous anaphylaxis, reported anxiety caused by epinephrine autoinjectors, and experienced mouth and throat itching, tight throat, dyspnea, shortness of breath, wheezing, urticaria, abdominal cramps and lightheadedness during allergic reactions.

This study reports worse FAQoL for adolescents as compared with younger children, with increasing scores with each year of age. This could be secondary to their increased responsibilities, peer pressure and bullying. Families who reported limitations in family activities as well as increased levels of stress surrounding the diagnosis of their child’s food allergy had worse FAQoL. This could be secondary to the increased effort the patients’ families face in keeping their children safe (issues involving meal preparation, school, restaurants, camps and sleepovers). Higher rates of anaphylaxis in adolescents was attributed to more time with the food allergy and higher risk taking behavior, stress with carrying epinephrine for teenagers as compared with parents to their reluctance to carry and use it, and the increase in subjective and respiratory symptoms to their ability to verbalize symptoms and to have more severe reactions.

The FAQLQs have a minimal clinically important difference of 0.5. This study shows that a difference of 3 to 6 years could significantly influence FAQoL. This was a cross-sectional study, so we cannot comment on how an individual’s FAQoL changes throughout childhood development; however, there does appear to be a difference in the influence of food allergy on FAQoL based on age. This study shows the importance of evaluating FAQoL in all patients, but with a particular focus on adolescents. It also highlights the importance of trying to safely include the child with food allergies in usual activities, because this exclusion contributes to impaired FAQoL. This study is limited by parent-reported FAQoL for children under 12 as compared with patient report for adolescents, which is not a direct comparison for these populations. In addition, there were only 24 adolescent questionnaires, <15% of the sample.