The Impact of Food Hypersensitivity Reported in 9-Year-Old Children by Their Parents on Health-Related Quality of Life
Authors: Pistiner Michael 
Published: October 2008

Ostblom E, Egmar A, Gardulf A, Lilja G, Wickman M. Allergy. 2008;63(2):211–218

PURPOSE OF THE STUDY. To examine the impact of reported food hypersensitivity (FHS) in 9-year-old children on parental perception of health-related quality of life (HRQoL).

STUDY POPULATION. A population-based birth cohort of 4089 Swedish children was used for a nested case-control study based on age 4 questionnaires (689 subjects, 689 controls). Parents completed questions pertaining to HRQoL at 9 years of age (∼75% completion).

METHODS. FHS was defined as parental report of wheezing/prolonged cough, runny/stuffy nose in the absence of a cold, itchy/watery eyes, eczema, urticaria, vomiting/diarrhea, or other symptoms after ingestion of a specific food in the last year. Those with previous FHS but avoiding the food were considered to have FHS. Pronounced FHS was defined by wheezing/prolonged cough, &gt;1 symptom, or symptoms occurring &gt;1 time per month. A validated 28-item form was used to explore parental perceptions of their children's HRQoL and was supplemented by a disease-specific nonvalidated questionnaire. Children with FHS at age 9 (212) were compared with those without FHS but with asthma, allergic rhinitis, or eczema (221) and to those with no allergic disease (581).

RESULTS. Primary analysis showed that compared with children with asthma, allergic rhinitis, or eczema but no FHS, those with FHS had significantly worse scores on physical functioning, limitations in school or social activities resulting from physical problems, and decreased perception of overall health (there were significant differences in additional subscale scores between those with FHS and those without any allergic disease). Even greater differences were observed for those with pronounced FHS and for those with high specific immunoglobulin E to foods. On the basis of the disease-specific questionnaire, parents reported significantly more feelings of sadness/restriction in everyday life and family conflicts for those with pronounced FHS compared with those with more mild or infrequent symptoms.

CONCLUSIONS. FHS had a significant impact on parentally reported HRQoL of 9-year-old children and their families.

REVIEWER COMMENTS. This study supports that there is a negative impact of adverse food reactions on perceived HRQoL. This unselected population may more accurately represent patients seen by pediatricians than populations used in previous QoL studies (tertiary care centers). The authors’ definition of FHS included a heterogeneous group of adverse food reactions (∼40% not doctor diagnosed), but there was a significant negative impact on perceived HRQoL regardless of the etiology. It is interesting to note that the subjects with “physician-diagnosed food allergy” had significantly better scores in limitations in school or social activities resulting from emotional or behavioral problems and scored no worse than those without a diagnosis of food allergy on any subscale, which emphasizes the importance of appropriate management. The pediatrician plays a critical role in initiating the appropriate evaluation (eg, determining by history if there is a likely food allergy) and management (eg, avoidance instructions, prescription of self-injectable epinephrine, referral to an allergist, etc) that may improve HRQoL.