By: Sherry Coleman Collins, MS, RDN, LD
Food allergy management requires vigilance over every bite of food to avoid uncomfortable and potentially life-threatening reactions. This fear can cause families to avoid dining out, social activities and even play dates with friends or relatives. Those with food allergies can face criticism related to their food allergy. In fact, according to a 2013 study of 251 families of children with food allergies, 31.5% of children and 24.7% of the parents reported bullying related to food allergies (1). Limitations to this study include self-reported data and the subjects are not demographically representative of the U.S. population as a whole, meaning the findings cannot be generalized. Even so, food allergies are often a life-long condition and these negative factors can take a toll.
Researchers have long noticed the negative impact of having a food allergy diagnosis on emotional health. According to a 2021 study with 382 participants representing adults, adolescents and parents of those with peanut allergies, mental/psychosocial impacts were more significantly problematic than those to physical health (2). As with the previous study, the study limitations include self-reported data, which is subject to bias. More research is needed to better understand this issue.
While research tells us that death due to food allergy reactions is rare, anaphylaxis is a real threat to those with food allergies and the worst-case scenario makes the headlines (3). Healthcare providers should balance education for avoidance strategies and preparing for reactions with evidence-based context for true risk and address common misconceptions to protect quality of life for those managing food allergies. Shared decision-making can be helpful, as well as remaining aware of the potential impact on quality of life. The National Peanut Board provides funding for more research around quality of life related to peanut allergies.
The good news is that anxiety and poor quality of life aren’t inevitable. Here are several evidence-based interventions that may help those managing food allergies.
Improved Parental Self-efficacy
How confident a parent feels in taking care of their child with a food allergy plays a big role in the caregiver’s quality of life. A 2016 study of 434 parents of children with food allergy found that the greatest factor in parental quality of life was directly related to the parent’s self-reported self-efficacy for managing their child’s condition (4). Although a large sample size, study limitation included that most surveys were completed by mothers and it relied on parent-reported food allergy diagnosis. Parents can learn more about managing their child’s food allergy by working with their healthcare team, a food-allergy registered dietitian and family therapist.
Oral Immunotherapy (OIT)
OIT increases the threshold for those with food allergies, meaning that accidentally eating a small amount of the food is less likely to cause anaphylaxis. In a 2020 study of 21 peanut-allergic individuals, researchers found that having participated in “real world” peanut OIT significantly improved quality of life (5). Study limitations include the small sample size. FDA-approved peanut OIT Palforzia is now widely available. While not a cure, it may lead to improved quality of life.
Oral Food Challenges (OFC)
An OFC is conducted in a clinical setting, under the supervision of a physician, and requires the individual to eat the food they believe they are allergic to in small amounts until they have eaten a full serving or have an objective reaction. OFCs are not without their risks, since an individual will eat the food they are allergic to. However, a 2018 systematic review analyzed seven studies (n=1370) that showed that food allergy-specific parent-reported quality of life measures improved significantly following OFC regardless of whether the child passed the challenge or not (6).
Many individuals with food allergies mistakenly think that just being near the food they’re allergic to can cause a life-threatening reaction. This results in unnecessary anxiety. Dinakar and colleagues describe the “transforming power of proximity food challenges” as being an effective way to bring these patients relief (7). In this scenario, the clinician brings the food (e.g. peanut butter) into the room with the child, opens it and bring it closer so that the child sees it isn’t unsafe to be near. They may also apply the food to their skin under observation. Researchers report never having had a child react to just being near the food and report only one case of a hive at the site of application. Of course, these patients still cannot eat the food they are allergic to but knowing that they can be near without a reaction can be a freeing experience.
- Shemesh, E. A. (2013). Child and Parental Reports of Bullying in a Consecutive Sample of Children With Food Allergy. Pediatrics, e10-e17. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529950/
- Nowak-Wegrzyn, A. H. (2021). The Peanut Allergy Burden Study: Impact on the quality of life of patients and caregivers. World Allergy Organization Journal, 100512. https://www.sciencedirect.com/science/article/pii/S1939455121000065
- Turner, P. J. (2017). Fatal Anaphylaxis: Mortality Rate and Risk Factors. J Allergy Clin Immunol Pract, 1169-1178. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5589409/
- Knibb, R. B. (2016). Parental self-efficacy in managing food allergy and mental health predicts food allergy related quality of life. Pediatric Allergy and Immunology, 459-464. https://derby.openrepository.com/bitstream/handle/10545/604748/Self-efficacy%20and%20QoL_PAI_main%20document.pdf?sequence=6&isAllowed=y
- Blackman, A. S. (2020). Quality of life improves significantly after real-world oral immunotherapy for children with peanut allergy. Annals of Allergy, Asthma & Immunology, 196-201. https://www.annallergy.org/article/S1081-1206(20)30193-9/fulltext
- Kansen, H. L. (2018). The impact of oral food challenges for food allergy on quality of life: A systematic review. Pediatric Allergy and Immunology, 527-537. https://onlinelibrary.wiley.com/doi/pdf/10.1111/pai.12905
- Dinakar, C. S. (2016). The Transforming Power of Proximity Food Challenges. Annals of Allergy, Asthma & Immunology, 135-137.