Association of Reaction Symptoms and Eliciting Dose With Health-Related Quality of Life in Children With Peanut Allergy

Alice Hu; Melanie Lloyd; Paxton Loke; Adriana Chebar Lozinsky; Michael O'Sullivan; Patrick Quinn; Michael Gold; Mimi L K Tang

doi:10.1016/j.jaip.2023.06.063

Association of Reaction Symptoms and Eliciting Dose With Health-Related Quality of Life in Children With Peanut Allergy

J Allergy Clin Immunol Pract. 2023 Oct;11(10):3195-3202.e4. doi: 10.1016/j.jaip.2023.06.063. Epub 2023 Jul 7.

Authors

Alice Hu¹, Melanie Lloyd², Paxton Loke³, Adriana Chebar Lozinsky⁴, Michael O'Sullivan⁵, Patrick Quinn⁶, Michael Gold⁶, Mimi L K Tang⁷

Affiliations

¹ Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
² Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Centre for Medicine Use and Safety, Monash University, Parkville, Victoria, Australia.
³ Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia; Department of Paediatrics, Monash University Clayton, Victoria, Australia.
⁴ Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁵ Immunology Department, Perth Children's Hospital, Nedlands, Western Australia, Australia; Paediatrics Division, Medical School, University of Western Australia, Perth, Western Australia, Australia.
⁶ Discipline of Paediatrics, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Department of Allergy and Clinical Immunology, Women's and Children's Health Network, North Adelaide, South Australia, Australia.
⁷ Allergy Immunology, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia. Electronic address: mimi.tang@mcri.edu.au.

PMID: 37423341
DOI: 10.1016/j.jaip.2023.06.063

Abstract

Background: Food allergy adversely affects the health-related quality of life (HRQoL) of patients. It is unclear whether factors such as the reaction eliciting dose (ED) and the nature of allergic reaction symptoms affect HRQoL.

Objective: To explore associations between reaction ED or the nature of allergic symptoms and HRQoL among children with peanut allergy.

Methods: This study was a secondary analysis of baseline data from the PPOIT-003 randomized trial in 212 children aged 1 to 10 years with challenge-confirmed peanut allergy. Children's past reaction symptoms were collected by clinicians during screening. Associations between variables of interest and parent-reported child-proxy HRQoL were examined by univariable and multivariable linear regression.

Results: Mean age of study participants was 5.9 years; 63.2% were male. Children with a low reaction ED of 80 mg peanut protein had significantly poorer HRQoL (β = -0.81; 95% CI, -1.61 to -0.00; P = .049) compared with children with a high ED of 2,500 mg peanut protein. Gastrointestinal symptoms (β = 0.45; 95% CI, 0.03-0.87; P = .037), lower airway symptoms (β = 0.46; 95% CI, 0.05-0.87; P = .030), multisystem involvement (β = 0.71; 95% CI, 0.25-1.16; P = .003), or anaphylaxis (β = 0.46; 95% CI, 0.04-0.87; P = .031) during a previous reaction were associated with worse HRQoL.

Conclusions: Peanut-allergic children with a lower allergen reaction threshold experienced a greater negative HRQoL impact compared with children with higher reaction thresholds. In addition, specific past allergic reaction symptoms were associated with comparatively worse HRQoL. Children experiencing these symptoms and those with lower reaction ED require increased clinical support to manage the food allergy and are likely to benefit from interventions that can improve HRQoL.

Keywords: Allergic reaction symptoms; Eliciting dose; Food allergy; Peanut allergy; Quality of life.