Food allergy-related concerns during the transition to self-management

Food allergy on US college and university campuses: A systematic literature review

Objective: Determine how food allergy (FA) is managed on college campuses from both an institutional and student perspective. Methods: A systematic literature review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses principles. Results: Colleges/universities included in our sample were not fully equipped for handling FA emergencies, and most were lacking FA resources. While the need for FA training was found to be needed by both students and dining hall staff, there were no such programs currently available. Also, students did not feel safe in their college environment and were frequently anticipating an allergic reaction. Despite this fear, students with FA were also not carrying their SIE on their person. Additionally, the Americans with Disabilities Act was not mentioned in any of the reviewed studies, food allergy is a disability condition covered by this Act. Conclusions: More research needs to be done in this area to evaluate current procedures and determine areas of improvement to benefit college students with FA.

Food Allergy-Related Bullying in Pediatric Patients: A Systematic Review

BACKGROUND

Food allergy (FA)-related bullying is a significant public health concern affecting pediatric patients. This systematic review investigates the prevalence, characteristics, and psychosocial impact of FA-related bullying, as well as current intervention strategies within educational and healthcare settings.

METHODS

A systematic literature search was conducted across the PubMed, Web of Science, and CINAHL databases, covering publications up to February 2024. The review followed PRISMA guidelines and included studies on children and adolescents (0-18 years) diagnosed with FAs. Studies were selected based on eligibility criteria and assessed for quality using the Newcastle-Ottawa Scale.

RESULTS

The initial search identified a total of 260 records (6 from scientific databases and 254 from registries). Twenty-six studies met the inclusion criteria. The findings of these studies reveal that FA-related bullying is prevalent, with rates varying between 17% and 60%, depending on the study population and methods. Bullying often involves verbal teasing, social exclusion, and physical threats using allergens, presenting both psychological and physical risks. Psychological consequences include increased anxiety, depression, and social withdrawal, which persist over time, significantly impacting quality of life for both children and their families. Notably, bullying often occurs in school settings, emphasizing the need for targeted interventions.

CONCLUSION

FA-related bullying profoundly affects mental health and quality of life for affected children and their families. Interventions, such as school-based allergy education programs and policies promoting inclusivity and safety, have shown promise in reducing bullying incidents. A collaborative approach involving healthcare providers, educators, and policymakers is essential to mitigate the impact of FA-related bullying and improve outcomes for affected children.

Exploring young adults' experiences with food allergy during their teenage years: A practice research study

INTRODUCTION

Symptoms of anxiety, eating disorders and social isolation are prevalent among teenagers with food allergy compared to peers without. Treatment of teenagers with food allergy focus on preventing anaphylactic reactions, with little attention to promoting social and emotional well-being. The aim of the study was to explore young adults' perspectives on everyday life with food allergy during their teenage years to improve future clinical practice.

METHODS

Critical psychological practice research. During a 2-day camp the perspectives of 10 young adults (18-23 years) were explored through participant observation and informal interviews. Three follow up interviews were conducted. A co-researcher group discussed preliminary results, clinical challenges and ways forward.

RESULTS

Being together with peers with food allergy was crucial, fostering belonging and normalisation. The shift in responsibility of managing the risk feels overwhelming and stressful during teen age. Self-understanding was influenced when managing food allergy in social contexts, inducing feelings of burden and isolation. Acceptance and understanding from social relations became important for all participants, and they all underlined desire for being viewed as individuals rather than being defined by their allergy.

CONCLUSION

Support from other peers with food allergy is crucial for the participants. Transition to independently managing risks introduces uncertainty and social constraints, affecting self-understanding and interactions. Clinicians should prioritise peer support and empower teenagers in managing the risk and psychosocial challenges.

Quality Appraisal of Quality of Life Research in Children and Adolescents with Food Allergy: A Systematic Review

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.

Food Allergies and Quality of Life among School-Aged Children and Adolescents: A Systematic Review

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.

Associations between food allergy, country of residence, and healthcare access

BACKGROUND

To date, little consideration has been given to access to allergy-related care, despite the fact that food allergy affects a considerable proportion of children. As such, the current study aimed to describe access to food allergy-related services in Canada and the United States (US).

METHODS

Participants were recruited via social media from March-July 2021 and were asked to complete an online survey focused on food allergy-related medical care. Participants were Canadian and US residents who live with a child < 18 years old, with ≥ 1 food allergy. A series of logistic regressions were used to assess the associations between country of residence and type of allergy testing utilized during diagnosis.

RESULTS

Fifty-nine participants were included in the analysis (Canadian: 32/59; 54.2%; US residents: 27/59; 45.8%). Relative to Canadian participants, US respondents were less likely to be diagnosed using an oral food challenge (OFC; OR 0.16; 95% CI 0.04; 0.75: p < 0.05). Compared to children diagnosed by age 2 years, those diagnosed at age 3 years and older were less likely to have been diagnosed using an OFC (OR 0.12; 95% CI 0.01; 1.01; p = 0.05).

CONCLUSIONS

Access to food allergy-related services, varies between Canada and the US. We speculate that this variation may reflect differences in clinical practice and types of insurance coverage. Findings also underscore the need for more research centered on food allergy-related health care, specifically diagnostic testing, among larger and more diverse samples.

Allergens sensitization among children with allergic diseases in Shanghai, China: age and sex difference

Background

The distribution of allergens has geographic characteristics. Local epidemiological data provides evidence-based strategies for the prevention and management of allergic diseases. Age and sex differences may exist in the prevalence of sensitivity to various allergens. We investigated the distribution of common allergens in allergic children in Shanghai, southeastern China.

Methods

39,926 children 1 month to 18 years of age diagnosed with allergic diseases were tested for the presence of serum-specific Immunoglobulins E (sIgE) to 17 allergens common to this region, using a reversed enzyme allergosorbent test.

Results

25,757 (64.5%) of the subjects showed elevated sIgE to at least one of the tested allergens. House mite and dust mite were the most common aeroallergens, while egg and milk were the most common food allergens. The most common aeroallergens and food allergens were similar among each allergic disease. By age-group analysis, the positive rates of aeroallergens were higher at older age. Several peaks of sensitization to food allergens were observed in children between 1 and 3 years of age for eggs, milk, nut, crab and shrimp. In addition, the sensitization to beef and mango was highest in children 3–6 years of age. The rate of positive sIgE detection was higher in males than females for all the tested allergens except cockroach, trees and beef. Considering the interplay between sex and ages and other related components (including season, monthly temperature, humidity, air quality index, test rate of patients), the sIgE positive rates of the main aeroallergens increased with age, while the main food allergens decreased; males are more sensitive to several aeroallergens (including dust mite, house mite, cat epithelium, dog epithelium and mulberry).

Conclusions

House mite, dust mite, milk, and egg are major allergens in Shanghai. Children at younger age are more sensitive to food allergens, while increasing overall prevalence of sensitization can be found with increasing age. Boys have higher positive rates of sIgE responses than girls. Knowledge of the prevalence of allergen sensitization in different age groups and sex may help facilitate diagnosis and intervention efforts to mitigate the impact of allergic diseases in this large geographical region. This approach may be extrapolated to other regions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12931-022-02008-7.

Living with Food Hypersensitivity as an Adolescent Impairs Health Related Quality of Life Irrespective of Disease Severity: Results from a Population-Based Birth Cohort

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.

The excess costs of childhood food allergy on Canadian families: a cross-sectional study

Background

The impact of childhood food allergy on household costs has not been examined in Canada. The current study sought to examine differences in direct, indirect, and intangible costs among Canadian families with and without a food-allergic child.

Methods

Families with a child with a specialist-diagnosed food allergy (cases) were recruited from two tertiary pediatric allergy clinics in the Province of Manitoba, Canada, and matched, based on age and sex, to families without a food-allergic child (controls). Cost data for the two groups were collected via an adapted version of the Food Allergy Economic Questionnaire (FA-EcoQ). Consideration was given to income, defined as above vs. below the provincial annual median income.

Results

Results from 35 matched case/control pairs revealed that while total household costs did not significantly differ between cases and controls, food-allergic families did incur higher direct costs ($12,455.69 vs. $10,078.93, p = 0.02), which were largely attributed to spending on food. In contrast, cases reported lower, but not statistically significant, total indirect costs compared to controls ($10,038.76 vs. $12,294.12, p = 0.06). Families also perceived their food-allergic child as having poorer quality of life relative to their healthy peers. Lastly, stratification of the analyses by annual income revealed several differences between the higher and lower income groups.

Conclusions

Relative to families without a food-allergic child, food-allergic families incurred higher direct costs across a number of different areas.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13223-021-00530-9.

Prevalence of allergen sensitization among 1,091 patients with urticaria

The etiology of urticaria is heterogeneous and allergic responses may be involved in it. The aim of the present study was to investigate the prevalence and distribution of sensitivity to inhaled and food allergens among patients with urticaria in Henan province (China). The levels of specific immunoglobulin E (sIgE) were detected using the AllergyScreen test and a total of 524/1,091 cases (48.0%) tested positive for sIgE to at least one of the 19 allergens. The most common inhaled allergens the urticaria patients were sensitive to were D. pteronyssinus (34.5%), cockroach (12.5%) and tree pollen mix (11.1%), while the food allergens with the highest rate of allergic reactions were cashew nut (8.1%), shrimp (6.8%) and crab (6.4%). The positive rates for D. pteronyssinus, dog hair, cockroach, mold mix, tree pollen mix and shrimp in the chronic urticaria group were higher than those in the acute urticaria group (P<0.05). Furthermore, positive rates for the majority of allergens were higher in males than in females and were significantly different between age groups (P<0.05). The results of the present study provided information on the characteristics of allergen sensitization of patients with urticaria and may facilitate the prevention, diagnosis and management of urticaria in Henan province.