Quality of Life Topics for Food Allergies

Why is evaluating quality of life important for food allergy diagnoses?

Evaluating quality of life (QoL) is crucial in food allergy diagnosis due to the significant impact that food allergies have on multiple aspects of the individual's life. Food allergy, considered a chronic condition, extends beyond physical health to affect psychological and social well-being. For instance, children with food allergies often experience higher levels of anxiety, and their families often report reduced QoL compared to peers without allergies.⁽¹⁾  Anxiety can stem from exposure to misinformation, constant vigilance and fear.   

Food Allery Research & Education (FARE) reports:

• 30% of children with food allergies are bullied. This increases in children with more than one allergen.
• 25% of children with food allergies are restricted from going to events their peers attend, e.g. camps, sleepovers
• Mothers of food-allergic children under 5 years old have significantly higher blood pressure measurements and stress compared to their peers

Key subsets of food allergy patients requiring heightened awareness from the dietitian during QoL evaluations

Children with:

• More than one food allergy
• Severe food allergies
• In the early years of life
  When developing their relationship with food and shaping longterm behaviours and perceptions
• Adolescents and young adults
  This group is particularly sensitive to social dynamics and may experience increased anxiety due to awareness of social norms and peer interactions

More can be learned here regarding the challenges of managing multiple food allergies and the consequent food aversions.

QoL can be assessed using validated tools, such Food Allergy Quality of Life Questionnaire- Parent Form for caregivers of children under 12 years, developed by the National Institute of Health (NIH). Alternatively, the Scale of Food Allergy Anxiety (SOFAA) developed by Children’s hospital of Philadelphia, for assessing anxiety and related anxious avoidance behaviours. The  SOFAA- C is for adolescents ages 8-18 year old. The SOFAA-P is the corresponding parent-rated version, which assesses different QoL considerations for caregivers. The SOFAA scales and interpretation guide may be found here. The SOFAAs tools were developed by a cognitive-behavioral therapist (CBT) specializing in pediatric anxiety (KKD), in coordination with food allergy medical professionals and parents of children with food allergies.

One-third of children in the US have experienced bullying due to their condition, and many do not inform their parents. Bullying related to food allergies can lead to social isolation and emotional distress.⁽⁴⁾ In some states, food allergy bullying is considered as disability harassment, reflecting the seriousness of its impact. There have been several bullying episodes reported by the media in 2024, including one case where a 13-year-old was arrested on felony charges. You can read about it here. In another incident, students were not charged after covering a peer's locker and clothing in peanut products. You can read about it here.

 Key considerations that can impact QoL for children and caregivers include:

• Age
• Perceived food allergy severity
• Reaction history
• Emotional stress related to meal planning and preparation, eating at restaurants or outside the home.
• Events and activities at school often involve food
• The constant vigilance associated with food allergen avoidance can cause stress for both children and their families.

A parental questionnaire, the Food Allergy Quality-of-life Questionnaire – Parent Form (0–12 years), can be used with parents or professionals as a guide to assessing potential quality of life issues.  It has a section for all ages, and additional sections for specific ages (4-12 years old, 7 to 12 years old).  It also has sections related to specific concerns, e.g. worries about food safety and your concerns as a parent.

The questionnaire can be downloaded at https://www.ncbi.nlm.nih.gov/books/NBK263525/.  Parameters for using the questionnaire in research and journal articles are shown on this page.  

For older children or teenagers who can respond to questions, the following types of questions may be used.⁽⁴⁾

HOW MUCH HAVE YOU BEEN TROUBLED BY THE FOLLOWING AS A RESULT OF YOUR ALLERGIES IN THE PAST WEEK?

Questions are all answered using the following scale: not troubled (0), hardly troubled at all (1), somewhat troubled (2), moderately troubled (3), troubled quite a bit (4), very troubled (5), extremely troubled (6).

References:

1. Venter C, Groetch, M., James, J., Sicherer, S.. Health Professional's Guide to Nutrition Management of Food Allergies. Academy of Nutrition and Dietetics; 2023.
2. Walkner, Madeline & Warren, Christopher & Gupta, Ruchi. (2015). Quality of Life in Food Allergy Patients and Their Families. Pediatric Clinics of North America. 62. 10.1016/j.pcl.2015.07.003.
3. Skypala I, Bauer M, DunnGalvin A, Venter C. The Challenges of Managing Multiple Food Allergies and Consequent Food Aversions. J Allergy Clin Immunol Pract. 2022 Jan;10(1):35-44. doi: 10.1016/j.jaip.2021.10.044. Epub 2021 Oct 28. PMID: 34757065.
4. Appendix 2 Food allergy quality-of-life questionnaire – parent form (0–12 years), Study of induction of Tolerance to Oral Peanut: a randomised controlled trial of desensitisation using peanut oral immunotherapy in children (STOP II).  National Library of Medicine.  Accessed 8 September 2024.  Available at:  https://www.ncbi.nlm.nih.gov/books/NBK263525/
5. Development of a quality-of-life assessment for the allergic child or teenager with multisystem allergic disease.  Available at: https://www.jacionline.org/article/S0091-6749(02)91257-1/fulltext. Accessed 18 August 2024
6. Shemesh E, Annunziato RA, Ambrose MA, Ravid NL, Mullarkey C, Rubes M, Chuang K, Sicherer M, Sicherer SH. Child and parental reports of bullying in a consecutive sample of children with food allergy. Pediatrics. 2013 Jan;131(1):e10-7. doi: 10.1542/peds.2012-1180. Epub 2012 Dec 24. PMID: 23266926; PMCID: PMC3529950.
7. Lee S. Assessment of Quality of Life in Food Allergy. Allergy Asthma Immunol Res. 2023 Jan;15(1):4-7. doi: 10.4168/aair.2023.15.1.4. PMID: 36693353; PMCID: PMC9880303.