# Impact of Childhood Food Allergy on Quality of Life: A Systematic Review
## 3 Results
### Interpersonal Dimension  
As noted, food allergies not only impact the child's life but also affect their families and the interactions between them [30; 35]. Families reported experiencing physical, psychological, and social burdens [36]. This burden was greater in families with children who had food allergies, in cases where there was a history of allergic medication use, and among non-working caregivers [37]. Several studies found no relationship between the gender of the caregiver or child and parental burden, nor were there racial differences [37; 38; 39; 40]. Caregivers frequently reported high concern about accidental exposure to allergens and the fear of anaphylaxis [33; 41]. These concerns were heightened in less controlled environments such as schools, restaurants, or during travel [26; 33; 39]. As a result, parental burden was often linked to limitations in social activities [27; 36]. This situation had a significant impact on the family's social life, leading to food restrictions, conditioned choices in restaurants (to avoid cross-contamination), and additional planning for vacations, especially for distant destinations [33; 34; 39]. In most cases, caregivers had to prepare allergen-free meals, which added economic challenges, along with the costs of specific foods and treatments [36]. Preparing these meals also required increased time, vigilance, and stress, all of which reduced caregivers' quality of life [36; 41]. In some cases, families opted to prohibit the allergen-containing food at meals or to eat separately from the allergic child when consuming such foods [41]. As a result, the most common emotions experienced by families were anxiety and depression, which decreased their health-related quality of life [38; 42]. The negative emotions most commonly reported by family members were stress, worry, uncertainty, and frustration [33; 34]. This symptomatology was primarily influenced by factors such as a history of anaphylaxis, the child's age, and the number and severity of allergies [26; 28; 29; 38; 42]. Along similar lines, ref. [43] found that parents of children aged up to seven years, with three or more allergies and a history of anaphylaxis, had higher levels of anxiety. Anxiety was also greater when there was comorbidity with other chronic diseases, such as asthma, as these increased the risk of more severe reactions [25; 31]. Anxiety contributed to hypervigilance and associated distress [42]. Another influencing factor was the level of control caregivers could exert over the child; greater control was linked to lower levels of anxiety [34]. However, overprotection or excessive parental control increased the risk of imposing an emotional burden on the child [42]. In this context, ref. [39] emphasized the importance of parental self-efficacy, which was found to be independent of the family's economic situation. Higher self-efficacy reduced parental burden and was a predictor of psychosocial well-being, increasing health-related quality of life and reducing the perception of risk or severity of the food allergy [38; 39]. Study [44] found that caregivers with high self-efficacy promoted greater sociability and activity in their children, while low self-efficacy increased worry and limited the child's life. A notable finding was the difference in perception between children and their caregivers regarding the allergy, with adults perceiving a greater negative impact on the child's health-related quality of life than the child did [26]. Food allergies also affected caregivers' work environments. Some caregivers reduced their work hours, accepted jobs with fewer responsibilities to accommodate medical appointments, or were absent from work to take their child to the emergency room due to a reaction [33; 34; 38]. Thus, caregivers' working conditions were directly related to parental burden [37]. Several studies emphasized that mothers were more affected, experiencing higher levels of stress and anxiety and a greater impact on their quality of life [28; 41].