The impact of food allergy on household level

Adverse reactions to food can be caused by food hypersensitivity. Prominent examples include food allergy or food intolerance. Patients suffering from food hypersensitivity have inappropriate autoimmune system reactions to potentially harmless food components. Symptoms can vary from uncomfortable skin rashes to cardiovascular problems such as anaphylactic shock. To date, no general cure is available. As a consequence, the management of food allergy consists of allergen avoidance, which may cause negative consequences in terms of patient anxiety and their experience of quality of life. Furthermore, implementation of dietary restrictions can have a negative effect on the quality of life and economic functioning of not only the food allergic patient but also their family members. An important issue in the assessment of the impact of food hypersensitivity and food allergy is the assessment of the economic costs that accrue to afflicted consumers. This information will contribute to the prioritising of healthcare resources, as well as developing effective policies to insure consumer protection. It is also important to evaluate whether wellbeing and welfare are affected. If this is indeed the case, a question arises as how to best manage dietary avoidance strategies. The aim of the research reported in this thesis is to provide information salient to the assessment of the impact of food hypersensitivity and allergy on households with respect to costs (time and money), welfare, well-being, and information search strategies. A systematic review of the existing literature revealed that researchers had not yet developed and validated an instrument to measure the individual and household costs of food hypersensitivity and/ or allergy. This thesis describes the development of the “household costs of food allergy” questionnaire and the exploratory analyses applied to validate the instrument. Thereafter, the “household costs of food allergy” questionnaire was used on a large sample of clinician-diagnosed food hypersensitive patients to confirm these cost effects. This study was part of an epidemiological study to investigate the prevalence of food allergy and food intolerance in four European countries, data were collected in The Netherlands, Poland, Spain and the United Kingdom. The respondents in this study were either diagnosed with food allergy or food intolerance. For the purposes of this discussion, the term food hypersensitivity will be used to indicate both diseases. Contrary to expectation, households with food hypersensitive respondents had significantly lower direct and indirect costs across all countries compared to households without food hypersensitive members. In addition, no differences in welfare between food hypersensitive respondents and respondents asymptomatic to foods were found. However, adult food hypersensitive respondents and their spouses reported significantly less happiness than respondents, or their spouses, who were asymptomatic. Thus, the results presented in this thesis do not support the commonly held belief of clinical researcher and patient organisations that all food allergies incur high costs to the individual. Given that an individual’s experience of quality of life is negatively impacted by food hypersensitivity, it is feasible that this might be improved by the implementation of more effective management strategies. As the primary viable management strategy involves avoidance of problematic foods, facilitating consumer choice in the retail environment may optimise risk management. The labelling preferences of food allergic consumers were investigated in two European countries, The Netherlands and Greece. At the time the research was conducted, food legislation had been developed to facilitate management of food allergens in order to protect food allergic consumers, rather than food intolerant consumers. For this reason, the research was confined to the study of the information needs of food allergic patients, and how this related to the current legislative situation. The research utilised ethnographic interviews with food allergic consumers during the course of shopping in a supermarket. The results suggest that current labelling practice is perceived to be inadequate for food allergic consumers if safe food choices are to be made. This is due to inappropriate use of fonts, colours with low contrasts and inconsistencies in the different languages, application of precautionary labelling, and lack of European and international harmonisation in labelling legislation. Based on these results, new information scenarios, such as uniform labelling, information booklet and ICT solutions, were developed and tested through an online survey. The results were used to develop prototype information delivery tools. An experiment was conducted to understand if the information delivery was in fact optimal, and to confirm if the additional attributes of the prototype tools were sufficient to facilitate allergen avoidance. The results suggested that the label should show the percentages of the allergens in the food product, as well as provide specific details about allergy management in the food chain, and use standardised symbols and standardised location of allergy information on the package. Additional visual and auditory warnings were also treated as being important for the ICT driven information delivery approaches, the results indicated that ICT methods are not appropriate replacements for effective food labelling on packaging, but may be used to supplement information provided by labels. To conclude, this thesis provides insight in the financial impact of food hypersensitivity, as well as the welfare and well-being. The “household costs of food allergy” questionnaire can be used by regulators and policy makers to prioritise healthcare resources, as well as to test the effectiveness of policy interventions. Limitations in current risk management strategies based on consumer information were also identified. The results of the consumer preferences studies can be used by policy makers and food industry to optimise the information delivery to food allergic consumers and therewith improve their quality of life. The combination of economic research and consumer research is relevant to investigate the dynamic impact of food allergy on individuals and their families. <br/

Amino Acid-based Formula in Cowʼs Milk Allergy: Long-term Effects on Body Growth and Protein Metabolism. A Randomized Trial

Objectives: The long-term effects of amino acid-based formula (AAF) in the treatment of cow's milk allergy (CMA) are largely unexplored. The present study comparatively evaluates body growth and protein metabolism in CMA children treated with AAF or with extensively hydrolyzed whey formula (eHWF), and healthy controls. Methods: A 12-month multicenter randomized control trial was conducted in outpatients with CMA (age 5-12 m) randomized in 2 groups, treated with AAF (group 1) and eHWF (group 2), and compared with healthy controls (group 3) fed with follow-on (if age 12 months). At enrolment (T0), after 3 (T3), 6 (T6), and 12 months (T12) a clinical evaluation was performed. At T0 and T3, in subjects with CMA serum levels of albumin, urea, total protein, retinol-binding protein, and insulin-like growth factor 1 were measured. Results: Twenty-one subjects in group 1 (61.9% boys, age 6.5\ub11.5 months), 19 in group 2 (57.9% boys, age 7\ub11.7 months) and 25 subjects in group 3 (48% boys, age 5.5\ub10.5 months) completed the study. At T0, the weight z score was similar in group 1 (-0.74) and 2 (-0.76), with differences compared to group 3 (-0.17, P<0.05). At T12, the weight z score value was similar between the 3 groups without significant differences. There were no significant changes in protein metabolism in children in groups 1 and 2. Conclusion: Long-term treatment with AAF is safe and allows adequate body growth in children with CMA

Supporting Self-Care of Adolescents with Nut Allergy Through Video and Mobile Educational Tools

Anaphylaxis is a life-threatening allergic reaction which is rapid in onset. Adolescents living with anaphylaxis risk often lack the knowledge and skills required to safely manage their condition or talk to friends about it. We designed an educational intervention comprising group discussion around videos of simulated anaphylaxis scenarios and a mobile application containing video-based branching anaphylaxis narratives. We trialed the intervention with 36 nut allergic adolescents. At 1-year follow-up participants had improved adrenaline auto-injector skills and carriage, disease- and age-specific Quality of Life and confidence in anaphylaxis management. At 3-year follow-up adrenaline carriage improved further and confidence remained higher. Participants expressed how the education session was a turning point in taking control of their allergy and how the app facilitated sharing about anaphylaxis with others. We contribute insights regarding design of mobile self-care and peer-support applications for health in adolescence, and discuss strengths and limitations of video-based mobile health interventions