Psychosocial Burden of Multiple IgE-Mediated Food Allergies in Pediatric Patients and Caregivers in the FORWARD Study.

Background/

Objectives

Of the approximately 8% of children in the United States (US) with food allergy (FA), roughly 40% report allergy to multiple foods. The ubiquity and intensity of FA management can impose psychosocial burdens on both pediatric patients and caregivers, which may be exacerbated among those allergic to multiple foods. However, little work has comprehensively estimated the burden of multi-FA in heterogeneous pediatric populations with clinically confirmed FA.

Methods

Children with allergist-diagnosed, IgE-mediated FA were enrolled in the FORWARD multisite prospective cohort study. Psychosocial burden was assessed annually using the FA Quality of Life Questionnaire-Parent Form 10 (FAQL-PF10) and FA Independent Measure-Parent Form (FAIM-PF); psychosocial burden for caregivers was measured with the FA Quality of Life-Parental Burden (FAQL-PB) Questionnaire. Multilevel regression models estimated independent effects of the number of current FAs after adjusting for child age, gender, race, ethnicity, household income, caregiver education, atopic comorbidities, and recruitment site.

Results

FA-related psychosocial burden increased linearly for patients and caregivers with each additional FA even after controlling for demographic factors such as age, gender, race, ethnicity, income, education, and other atopic conditions, as well as repeated observations within participants: FAQL-PF10 B = 0.082 (N = 2206; p = 0.004), FAIM-PF B = 0.152 (N = 2206; p < 0.001), and FAQL-PB B = 0.166 (N = 1081; p < 0.001).

Conclusions

The psychosocial burden of pediatric FA increases monotonically with each additional current FA, highlighting opportunities for tailored psychosocial, behavioral, and pharmacologic interventions to improve FA-related outcomes among those most impacted.