RATIONALE: To describe QOL of children undergoing OFC in Canada and explore association between QOL, demographic/clinical characteristics, and parental confidence in recognizing anaphylaxis and using an autoinjector. METHODS: The FAQLQ-PF (higher score5poorer QoL; range50-6) was used to calculate QOL among children (n5166) undergoing OFC at the BC Children's Hospital Allergy clinic between Jan'14 and Oct'15. Linear regression was used to assess the relationship between QOL, demographic/clinical characteristics, and several confidence domains. RESULTS: Mean QOL score was 1.95 (95%CI: 1.71, 2.17) overall, 1.05 (0.47, 1.63) for tree nut, 1.70 (1.30, 2.11) for peanut, and 2.16 (1.74, 2.58) for egg. QOL was worse for older children (p50.001), having a health professional (HCP) parent (p50.02), experiencing more severe reactions (p50.04), and having ever administered an autoinjector (p<0.001). QOL was better for children undergoing OFC to tree nut compared with egg (p50.009). CONCLUSIONS: Health professionals are likely more aware of risks of food allergy, negatively affecting their child's QOL. Similarly, older children, those who've experienced severe reactions, and those who've used an autoinjector may be more worried about risks. Tree nut allergy resulted in better QOL than egg allergy, likely due to egg being harder to avoid. We found no association between QOL and several confidence domains, suggesting confidence with recognizing anaphylaxis and using an autoinjector is insufficient for improving QOL.

Munchausen syndrome by proxy is an illness which is very difficult to diagnose. It has a high morbidity and mortality rate. The knowledge of the characteristics of the victim and the perpetrator can be quite useful for its early recognition. The American Professional Society on the Abuse of Children, has recently brought the terms for the syndrome up to date. We look at this updating and present six cases diagnosed in our hospital, analysing their main features and comparing them with the medical literature.

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por poderes (SMP) constituye una particular forma de maltrato infantil cuya gravedad radica en su elevada morbimortalidad, difícil diagnóstico y posterior manejo. En los últimos años se han producido modificaciones terminológicas para designar este raro trastorno, con frecuencia infradiagnosticado. Aportamos la experiencia de 6 casos de SMP diagnosticados en los últimos ocho años. En todos ellos el agente causal fue la madre, generalmente de bajo nivel socioeconómico, con desestructuración importante del núcleo familiar y hasta en el 50% de los casos con alteraciones en la personalidad. La edad media de la víctima fue de 8,4 años, habiendo transcurrido hasta el momento del diagnóstico un tiempo medio de 34 meses con más de 20 consultas médicas realizadas durante el mismo. Aunque no ha sido nuestro caso, está descrita una elevada probabilidad de presentar secuelas a largo plazo e incluso muerte. Proponemos el abordaje de toda sospecha de SMP por un Equipo Interdisciplinario. Entre las medidas a tomar por este equipo destaca el diseño de una puerta de entrada hospitalaria alternativa al servicio de Urgencias, decidir el momento de confrontación con la familia, medidas legales a tomar y elaboración de un plan de seguimiento-intervención. Palabras clave: Desorden facticio por poderes, maltrato infantil, síndrome de Munchausen por poderes.

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