Excerpted from the Autumn 2007 issue of Allergy Today. For more articles like this, subscribe to Allergy Today, click here.

Avoidance and risk of reactions creates more stress – but may strengthen families

By Inga Stünzner


Food hypersensitive school-age children and their families are more affected by the risk of food reactions and the measures taken to avoid them than the actual severity of the allergy, according to a new Swedish study.

The authors, B Marklund, S Ahlstedt and G Nordström, published their study, “Health-Related Quality Of Life In Food Hypersensitive Schoolchildren And Their Families: Parents’ Perceptions”, on Medscape earlier this year.

It found that families whose children’s food-induced reactions involved breathing difficulties, which can be life threatening, experienced less stress than those whose children had gastro-intestinal symptoms.

They speculated that this could be because gastro-intestinal symptoms are experienced over a longer period of time, it is difficult to find the trigger and there is almost no medication for these kinds of symptoms.

“Consequently, parents may find it difficult to reduce the risk of inconvenience and to mitigate the child’s pain, and this may account for the association between a child’s gastro-intestinal symptoms and deterioration of parent’s emotional health-related quality of life.”

In contrast, the triggers for food-induced breathing difficulties are usually simple to identify and there are medical resources to treat the symptoms.

“Even though the risk of an acute reaction might cause worry and fear, one knows what to do when it occurs,” the authors wrote.

“It may be speculated that individuals and families with this kind of hypersensitivity problem develop coping strategies built on cooperation and communication with those around and between family members.”

It found that although such chronic conditions could be a strain on the whole family, they may actually strengthen family cohesion. This has also been found in several other international studies, including a US study that found family cohesion was stronger in families with peanut allergic children.

Other studies have linked support between parents and the extended family with family cohesion and high self-worth for the child. The authors stated this was an area that needed more study, as it could generate valuable knowledge on how best to support families with food hypersensitive children.

The study surveyed 147 schoolchildren with parent-reported food hypersensitivity at a nine-year compulsory school and at the upper secondary school in a municipality in the south of Stockholm, Sweden. Food hypersensitivity includes allergy and intolerance. The authors asked parents of a food hypersensitive child how they perceived the child's, their own and the family's health-related quality of life (HRQL)? They were interested in the relationship between allergy-associated parameters, age and gender and the child, parent and family HRQL.

“It is first and foremost the children's parents who are responsible for not exposing their children to potentially dangerous dietary products, and food hypersensitivity in a child often leads to the whole family having to adapt to new food and eating practices,” the authors write.

“Yet, little is known of how child food hypersensitivity affects parents’ HRQL and what aspects of the hypersensitivity condition relate to HRQL deterioration in the family. Thus the aim of the study was to investigate the parent-reported HRQL in families with a schoolchild considered to be food hypersensitive.”

It found that those children who suffered from allergy-associated conditions, such as asthma, hay fever and eczema, in addition to food-related problems reported a greater impact on the physical quality of life than those without such chronic problems. However, the impact on the physical quality of life for children with only food hypersensitivity was no different than that reported for the general population.

“This is not surprising as the allergic diseases asthma, eczema and rhino conjunctivitis to a great extent are physical disorders with somatic symptoms,” the authors wrote.
Less expected was their finding that food hypersensitivity had the same psychosocial impact whether or not the child had other allergy-associated conditions.

“In the present study more than half (55 per cent) of the children had not experienced any food reactions in the past 12 months. Still, all the children were reported to have lower psychosocial HRQL than the general population samples mentioned,” the authors wrote.

“This may suggest that it is rather the risk of food reactions and measures to avoid them that is associated with lower HRQL than the clinical reactivity induced by food intake.”
These findings mirror a British study by Avery et al that showed children with peanut allergy had a poorer quality of life, apparently related to anxiety, compared with children with diabetes.

“Studies from Sicherer et al and Primeau et al have demonstrated a psychosocial impact of food allergy on quality of life on both the child and its family. It has also been shown that the parents of food allergic children experience more distress and worry, and also more interruptions and limitations in usual family activities, compared with a US population sample,” the authors noted.

“Furthermore, the parents of peanut-allergic children report significantly more disruption in the child's daily activities and in their familial-social interactions than parents of children with rheumatological diseases.”

Families suffered more strain if there was more than one family member with food hypersensitivity.

“The research on risks for the sibling of a chronically ill child is comprehensive, but the linkage between psychosocial HRQL deterioration and there being more than one child in the family with a chronic disorder has, to our knowledge, not previously been reported.
“Although further research is needed to verify the coherence in these findings, it should be noticed that having more than one family member with food hypersensitivity is associated with HRQL deterioration.”

Source: Medscape January 2007