Objective: Research has established associations between parental self-efficacy (SE) related to managing their child’s food allergy (FA) and parent quality of life, but there has been limited examination of how parent variables predict child social outcomes. This study examined whether parental SE related to managing their child’s FA moderates the association between parental worry and activity limitation of the child. Methods: Parents of 218 children with parent-reported FA completed an online survey, which included measures of demographics, child FA characteristics, parental SE, parental worry, and social activity limitation. Participants were recruited locally and nationally through social media, e-mail listservs, and paper flyers in pediatricians’ and allergists’ offices in the region. Results: Linear regression results indicated that parental SE moderated the association between parental worry and limitation of child’s social activities, R2 = .14, F(3, 213) = 8.35, p < .001. Parents with higher SE were less likely to limit their child’s social activities, regardless of worry level, whereas parents with lower SE were more likely to limit child social activities as their reported worry increased. Conclusions: Findings suggest that SE may act as a protective factor against child’s activity limitation and impairment of social quality of life when parents report high levels of worry, suggesting treatment targets for anxious parents of children with parent-reported FA.

Food allergies (FAs) in children are increasingly common, and strict allergen avoidance and safety concerns place parents at risk for anxiety (Lau et al. in Pediatr Allergy Immunol 25:236-242, 2014). Assessing parental anxiety with generic instruments may not capture the unique experience of parents managing children's FAs. This study developed and preliminarily validated the 13-item Worry About Food Allergy (WAFA) questionnaire, a measure of FA-specific parental anxiety, in an online sample of 265 parents aged 22-66 (M = 40.25) of children with FAs. The WAFA showed good internal reliability (Cronbach's α = .89) and moderate convergent validity with other anxiety measures, indicating support for a reliable measure of a discrete, specific construct. Exploratory factor analysis indicated a single factor structure. Criterion validity was established through significant, small, positive correlations with relevant allergy variables. A coherent single factor measure, the WAFA, shows promise as a screening tool for parental anxiety in pediatric practice and FA management. Keywords Parental anxiety • Pediatric food allergy • Assessment • Measure developmentRecent prevalence rates for pediatric food allergy (FA) are estimated to be approximately 9% (Gupta et al., 2017), with 38.7% of children having a history of severe reactions (Gupta et al., 2011). Food allergy reactions can be life-threatening: In the US, every three minutes someone is sent to the emergency room due to a food allergy reaction (Clark, Espinola, Rudders, Banerji, & Camargo, 2011). The current management strategy for childhood food allergy is strict avoidance of the allergen, monitoring for cross contamination, carrying an epinephrine auto-injector, and yearly visits to the child's physician (Longo, Berti, Burks, Krauss, & Barbi, 2013). Although there is increasing focus on development of novel therapies such as allergen immunotherapy, which involves repeated exposure to increasing doses of the antigen (Burks, Laubach, & Jones, 2008), a recent analysis indicated risk for adverse reactions (Nurmatov et al., 2017), and long-term effects remain uncertain. As such, current practice in FA management generally remains focused on strict avoidance and preparation for a reaction.

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RATIONALE: This is the first study for the etiology and characteristics of the children presenting to the Qatar Pediatric Emergency Centers (PEC) with anaphylaxis. METHODS: Records of patients less than 14 years in the last 6 years were studied. National Institute of Allergy and Infectious Diseases/ Food Allergy and Anaphylaxis Network for Anaphylaxis diagnosis was used for categorization. RESULTS: Of the 1051 files studied, 390 were analyzed to be anaphylaxis with an incidence of 13.3 per 100,000 visits .Females encompassed 31% and mean age was 3 years with 17% below 1 year. Food covered 54% of the etiology with 20% tree nuts, 14% mixed nuts, 5% dairy products, 4% each for sesame seeds and eggs and 2% seafood. Insect venom was 25% with 48% of them black ants, medications 7%, aeroallergens 3% and idiopathic 10%. There was 1 case each for camel milk, latex and MMR vaccine. PICU admission was seen in only 5 asthmatic cases with no fatalities. Recurrent anaphylaxis was seen in 55%, biphasic in 2%. Of the comorbidities, asthma and eczema were 42% and 27% respectively. Adrenaline being first line treatment was injected in 91% and 83% were prescribed auto-injectors upon discharge. While 82% were given a referral for Allergy and Immunology Clinic, 60% were followed up and investigated. CONCLUSIONS: Anaphylaxis is common affecting 1/1000 Qatari pediatric population. While food allergy was the commonest cause, black ant was also prominent. Recognition of anaphylaxis, its etiology and management, both at physician and patient level needs to be achieved.

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