# Impact of Childhood Food Allergy on Quality of Life: A Systematic Review
## 4 Discussion  
The objective of this study was to conduct a systematic review, following the PRISMA method, on the impact of pediatric food allergies on quality of life. The results indicate that food allergies affect the health-related quality of life of both the child and their family environment. This poses a challenge for family members, as they must educate themselves about allergenic foods, manage the allergy, and learn coping strategies [46]. Additionally, health-related quality of life appears to decline as age increases and the condition progresses. As children grow older, they face greater responsibilities in managing their allergies, along with heightened social limitations and emotional impacts [47]. Similarly, higher levels of anxiety and depression can occur, stemming from the fear of accidental exposure and the risk of anaphylaxis, as well as feelings of sadness and frustration from being unable to consume foods that their peers can [47; 48]. When compared with healthy children of the same age, children with food allergies were found to have a worse general health perception but a better quality of life than those with other chronic conditions, such as asthma. On a familial level, parents and caregivers experience physical, psychological, and social burdens. They report high levels of stress, worry, uncertainty, and frustration, which lead to hypervigilance and anxiety, with the risk that overprotection could further burden the child. This was highlighted by the authors of [46], who noted that excessive vigilance could impair the child's quality of life more than the allergy itself or even the allergic reaction to food. Social limitations were particularly prominent, as food restrictions, difficulties in choosing restaurants, and meticulous trip planning posed significant challenges. Moreover, families faced added economic strain from purchasing suitable products or preparing safe meals. To navigate these social and economic limitations, study [48] found that participants employed strategies such as bringing their own food to events, informing organizers or venue staff, or having eaten beforehand. Similarly, the working lives of caregivers were affected, as they often had to take time off work for medical appointments or request reduced hours. Among the most prominent coping strategies were carrying an epinephrine injection, reading food labels, frequent handwashing, seeking social support, and maintaining an adequate family educational and economic level. As [49] highlighted, increasing caregivers' knowledge, along with social support, boosts parental self-efficacy, improving both their ability to cope with the allergy and their health-related quality of life. These findings align with those in this study and those of [50], who indicated that parental self-efficacy is crucial as a protective factor in reducing parental burden. However, mothers were frequently identified as being the most affected, experiencing higher levels of stress and anxiety, greater impacts on their quality of life, and expressing feelings of being overwhelmed and misunderstood. As noted by [51], although mothers displayed greater empowerment, their quality of life was poorer compared to fathers. In the academic setting, food allergies resulted in increased school absenteeism and a higher likelihood of experiencing bullying or mockery due to their condition, with many children reporting feelings of isolation. This was also found in the research of [48]. Conflicts with teachers and other parents often arose during events like birthdays or school festivities involving food, largely due to insufficient training and awareness. As identified in [49], many caregivers experienced hostility from other parents when trying to manage allergy risks in schools. These authors emphasized the importance of training and educating teachers to prevent such situations and reduce parental worry and child absenteeism. Similarly, ref.