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There is growing awareness of the societal burden of food allergy (FA), recently estimated to affect 8% of US children. While fatalities have occurred, they are extremely rare, and children with FA do not exhibit symptoms in the absence of allergen exposure. Nevertheless, data suggest that US children with FA suffer substantial impairments in quality of life comparable to those experienced by children with other severe chronic conditions such as type 1 diabetes and rheumatologic disease. Aspects of living with FA, which increase psychosocial burden, include anxiety linked to the constant threat of experiencing potentially life-threatening anaphylaxis as well as the constant vigilance and often stressful interpersonal encounters required to successfully avoid common food allergens in daily living. Although not all families require mental health services to address these psychosocial consequences, there is a developing literature that documents behavioral interventions used with children and families affected by FA. The purpose of this study is to measure psychosocial burden and identify correlates for the first time in a population-based sample of children meeting criteria for physician-confirmed FA with convincing reaction symptomatology.
Methods
The Food Allergy Independent Measure (FAIM) was developed to assess the aforementioned aspects of living with FA, believed to be the principal drivers of the FA-related impairments in quality of life. In the present study, we administered a population-based FA prevalence survey to a nationally representative sample of over 50,000 US households. We analyzed responses to a parent-proxy version of the FAIM for children who reported physician-confirmation and met published symptom-report criteria for a convincingly IgE-mediated food allergic reaction (N=2155). The mean FAIM score ranged from 1 to 7 where a higher score indicates greater psychosocial impact. Bivariate Wald tests and covariate-adjusted linear regression were used to identify associations with sociodemographic and FA characteristics.
Results
The estimated mean FAIM score was 3.21 (95% CI: 3.11-3.31) among US children with convincing physician-confirmed FA, which is comparable to previous US and European estimates gleaned from selected clinical samples. With respect to sociodemographic characteristics, mean FAIM scores in adjusted models were invariant across participant gender, race/ethnicity, insurance status, age, census region and census division. However, children from the highest earning households (>$150,000/year) had significantly lower FAIM scores, implying less psychosocial impact, compared with other income groups. Tree nut, wheat, peanut, egg, and/or milk allergies were associated with significantly higher FAIM scores. Reporting a current epinephrine auto-injector prescription or history of FA related emergency department visits were each associated with significantly higher FAIM scores in adjusted models.
Conclusions and Implications
These data indicate that the population-level psychosocial burden of FA is similar to previous estimates found in clinical samples. As measured by the FAIM, the burden is substantial and broadly distributed among US children. In light of previous work linking childhood FA to internalizing psychopathology, as well as adverse psychosocial impacts among siblings, parents and other caregivers, the social work community should be aware of this increasingly prevalent allergic disease and its adverse impacts on social functioning and well-being.