Medical clown support is associated with better quality of life of children with food allergy starting oral immunotherapy

Abstract

Background The start of oral immunotherapy (OIT) for food allergy is a critical period in the treatment process, with a potential to influence patient quality of life (QOL) and subsequently treatment outcome. The association of medical clowning with QOL at OIT initiation was examined. Methods Children aged 4‐12 years supported by a medical clown (MC) during the induction week of OIT for food allergy were studied. Children in the same age range starting OIT without the support of a MC served as controls. Parents of all children completed the Food Allergy Quality of Life Questionnaire—Parent Form (FAQLQ‐PF), and children aged 8‐12 years completed the Food Allergy Quality of Life Questionnaire—Child Form (FAQLQ‐CF). QOL scores of parents and children with and without a MC support were compared. Results Children with (n = 88) and without (n = 212) the support of a MC were comparable in demographics and clinical characteristics. The study group had a significantly lower single highest tolerated dose compared to controls (57 ± 83 vs 162 ± 274 mg protein, respectively, P < .001). Parental perception of the QOL of children was not associated with a MC support (P = .81) but rather with previous reaction severity (P < .01). In contrast, the QOL of children aged 8‐12 years (n = 119) was positively associated primarily with a MC support, total score 3.7 ± 1.1 vs 4.6 ± 1.3 (P < .001). Conclusions While the perception of QOL of parents of children with food allergy at OIT initiation is mainly associated with previous reaction severity, the QOL of the children themselves is primarily positively associated with MC support.

Effectiveness of educational interventions for quality of life of parents and children with food allergy: A systematic review

“…Only 2 studies [15,23] that reported significant interventions on quality of life did not show a high or serious level of risk.…”

“…The interventions provided were consultants, [19,21] providing educational materials, [15,20] cognitive behavioral therapy, [22] practice, [16,17] support, [23] and peer mentoring. [18] Among them, providing educational materials [15] and support [23] were reported as effective interventions for the children and parents' quality of life (Table 2).…”

“…There was no statistical difference between the groups. P = .76 7 [21] [23] Supported by a medical clown (MC) during the induction week of oral immunotherapy (OIT) for food allergy Provider: MC who graduated from the Dream Doctors organization The MC first met the patients at their arrival to the allergy clinic on the first day of OIT and supported them throughout the first up-dosing days Four days (up to 6 hours/ day).…”

“…[18,19] The majority of the study subjects were parents (six cases), [15,[18][19][20][21][22] and 3 studies included children. [16,17,23] The quality of life measurement tools used included the Food Allergy Quality of Life Questionnaire Child Form and Parent Form (FAQLQ-CF-PF), [19,[21][22][23] Food Allergy Quality of Life-Parental Burden Questionnaire (FAQL -PB), [15,17,18,20] and Pediatric Quality of Life Inventory (PedsQLadolescent version) [16,19] (Table 1).…”

“…Weinberger (2019) [17] Low Low Low Low Low Low Danchin (2016) [19] Serious Low Low Low Low Moderate Low Serious 7 Hiscock (2020) [21] Serious Low Low Low Low Moderate Low Serious 8 Epstein-Rigbi (2021) [23] Moderate Low Low Low Low Moderate Low Moderate 9 Ramos (2021) [18] Serious Low Low Moderate Low Moderate Low Serious…”