Differences in Caregiver Food Allergy Quality of Life Between Tertiary Care, Specialty Clinic, and Caregiver-Reported Food Allergic Populations

Abstract

Background: Food allergy is associated with diminished caregiver quality of life (QoL), but the heterogeneity of this effect is unknown.

Objective: The objective of this study was to explore potential differences in caregiver QoL between self-selected caregivers reporting a child with food allergy (SS) and caregivers with children followed at a food allergy referral center clinic (RC).

Methods: The Food Allergy Quality of Life Parental Burden (FAQL-PB) index and screening questions regarding the child's most severe food reaction were administered to caregivers of milk, egg, peanut, or tree nut allergic children. SS were recruited via the email and/or social media networks of 2 large national food allergy advocacy groups, and RC from a tertiary referral center specialty clinic.

Results: Among 2003 SS and 305 RC, the mean total FAQL-PB QoL score was 2.67. Compared with SS, RC had a lower (better) mean total QoL score (1.84 vs 2.81, P < .001), individual FAQL-PB domain scores (mean difference range 0.51-1.93; all P < .001), and lower QoL scores for all allergens (mean difference range 0.89-1.32; peanut P < .001, tree nut P < .001, milk P = .006, egg P = .001). In an adjusted multiple linear regression model, RC were associated with a lower QoL score (-1.6 [95% CI, -1.91 to -1.29], P < .001). Factor analysis of the index revealed 2 dimensions. A minimal clinically important difference of 0.3 was calculated for the FAQL-PB using the standard error of measurement method.

Conclusions: Caregiver food allergy QoL is heterogeneous, and worse among SS versus RC. Clinically and statistically significant differences were noted in the total, domain-specific, and allergen-specific QoL scores, which indicated that the food allergic population may be segmented and have different risk profiles and/or burdens of illness, despite a common diagnosis.

Keywords: Anaphylaxis; Epinephrine; Food Allergy Quality of Life-Parental Burden; Food allergy; Prevalence; Quality of life; Self-efficacy; Self-reported food allergy.