Low health‐related quality of life is associated with declining home introduction of suspected food allergens

Abstract

To the Editor, Food allergy should be adequately diagnosed or excluded to avoid anxiety and unnecessary elimination of foods. 1,2 Mothers who suspect their child to be food allergic appeared to be more anxious and eliminated (multiple) foods unnecessarily. 3 Furthermore, peanutallergic children avoided tree nuts even when this food was proven to be safe or had been eaten before without symptoms. 4 We recommend to gradually introduce the food at home following a standardized schedule for children who are referred due to suspected food allergy but deemed tolerant (i.e. very low probability of food allergy based on medical and dietary history) for a specific food. However, this advice is declined for numerous reasons by many parents. Next to this, parents, who accepted the advice at first, did not introduce the food as recommended. To avoid unnecessary elimination and improve personalized medicine, it is therefore worthwhile to address potential hesitation during the visit and preferably in a standardized way. Health-related quality of life (HRQL) questionnaires might be valuable during this diagnostic process in order to screen for possible factors that influence the willingness to introduce the food at home.

Food Allergies and Quality of Life among School-Aged Children and Adolescents: A Systematic Review

“…Eighteen studies were conducted in Europe, (5 in Sweden [ 39 , 45 , 46 , 47 , 48 ], 3 in Spain [ 49 , 50 , 51 ], 3 in the Netherlands [ 52 , 53 , 54 ], 1 in Germany [ 55 ], 1 in France [ 56 ], 1 in the UK [ 57 ], 1 in Norway [ 58 ], 1 in Denmark [ 37 ] and 1 in Greece [ 59 ], while 1 study included participants from multiple European countries [ 60 ]), 5 in North America (4 in USA [ 61 , 62 , 63 , 64 ] and 1 in Canada [ 65 ]), 2 in Israel [ 66 , 67 ], 1 in Russia [ 68 ], 1 in Turkey [ 69 ] and 1 in Japan [ 70 ]. Fifteen studies were cross-sectional, 4 were case-control studies, 4 had a prospective cohort design and 5 were interventional studies ( Table 4 and Table 5 ).…”

“…In 4 studies, only adolescents who answered by themselves participated [ 45 , 46 , 47 , 64 ] while, in 1 study, only children that answered by themselves were included [ 59 ]. Finally, in 5 studies, children and parents as proxies answered the questionnaire [ 50 , 54 , 55 , 58 , 67 ], in 2 studies, adolescents and parents as proxies were included [ 52 , 61 ] and, in 2 studies, the sample consisted of children and adolescents who answered by themselves [ 56 , 60 ].…”

“…Methods for diagnosis of FA were heterogeneous. In 11 studies, a physician’s diagnosis was used [ 46 , 50 , 52 , 54 , 57 , 59 , 61 , 63 , 64 , 65 , 70 ]. In 7 studies, diagnosis was based on the clinical history and a positive SPT or food-specific serum/blood IgE results [ 39 , 51 , 53 , 56 , 58 , 62 , 68 ].…”

“…Finally, an interesting finding comes from the recent study of de Weger [ 54 ] on children and their parents, who were recommended to introduce peanuts or tree nuts at home. It was revealed that children and parents who declined the advice had higher HRQoL scores, indicating worse QoL, compared to those who accepted those allergenic foods’ introduction [ 54 ].…”