Health-related quality of life among adolescents with allergy-like conditions – with emphasis on food hypersensitivity

BACKGROUND: It is known that there is an increase in the prevalence of allergy and that allergic diseases have a negative impact on individuals' health-related quality of life (HRQL). However, research in this field is mainly focused on individuals with verified allergy, i.e. leaving out those with self-reported allergy-like conditions but with no doctor-diagnosis. Furthermore, studies on food hypersensitivity and quality of life are scarce. In order to receive information about the extent to which adolescent females and males experience allergy-like conditions and the impact of these conditions on their everyday life, the present study aimed to investigate the magnitude of self-reported allergy-like conditions in adolescence and to evaluate their HRQL. Special focus was put on food hypersensitivity as a specific allergy-like condition and on gender differences. METHODS: In connection with lessons completed at the children's school, a study-specific questionnaire and the generic instrument SF-36 were distributed to 1488 adolescents, 13–21 years old (response rate 97%). RESULTS: Sixty-four per cent of the respondents reported some kind of allergy-like condition: 46% reported hypersensitivity to defined substances and 51% reported allergic diseases (i.e. asthma/wheezing, eczema/rash, rhino-conjunctivitis). A total of 19% reported food hypersensitivity. Females more often reported allergy-like conditions compared with males (p < 0.001). The adolescents with allergy-like conditions reported significantly lower HRQL (p < 0.001) in seven of the eight SF-36 health scales compared with adolescents without such conditions, regardless of whether the condition had been doctor-diagnosed or not. Most adolescents suffered from complex allergy-like conditions. CONCLUSIONS: The results indicate a need to consider the psychosocial impact of allergy-like conditions during school age. Further research is needed to elucidate the gender differences in this area. A team approach addressing better understanding of how allergy-like conditions impair the HRQL may improve the management of the adolescent's health problems, both in health-care services and in schools

Health-related quality of life, assessed with a disease-specific questionnaire, in Swedish adults suffering from well-diagnosed food allergy to staple foods

BACKGROUND: Our aim was to investigate the factors that affect health related quality of life (HRQL) in adult Swedish food allergic patients objectively diagnosed with allergy to at least one of the staple foods cow’s milk, hen’s egg or wheat. The number of foods involved, the type and severity of symptoms, as well as concomitant allergic disorders were assessed. METHODS: The disease-specific food allergy quality of life questionnaire (FAQLQ-AF), developed within EuroPrevall, was utilized. The questionnaire had four domains: Allergen Avoidance and Dietary Restrictions (AADR), Emotional Impact (EI), Risk of Accidental Exposure (RAE) and Food Allergy related Health (FAH). Comparisons were made with the outcome of the generic questionnaire EuroQol Health Questionnaire, 5 Dimensions (EQ-5D). The patients were recruited at an outpatient allergy clinic, based on a convincing history of food allergy supplemented by analysis of specific IgE to the foods in question. Seventy-nine patients participated (28 males, 51 females, mean-age 41 years). RESULTS: The domain with the most negative impact on HRQL was AADR, assessing the patients’ experience of dietary restrictions. The domain with the least negative impact on HRQL was FAH, relating to health concerns due to the food allergy. One third of the patients had four concomitant allergic disorders, which had a negative impact on HRQL. Furthermore, asthma in combination with food allergy had a strong impact. Anaphylaxis, and particularly prescription of an epinephrine auto-injector, was associated with low HRQL. These effects were not seen using EQ-5D. Analyses of the symptoms revealed that oral allergy syndrome and cardiovascular symptoms had the greatest impact on HRQL. In contrast, no significant effect on HRQL was seen by the number of food allergies. CONCLUSIONS: The FAQLQ-AF is a valid instrument, and more accurate among patients with allergy to staple foods in comparison to the commonly used generic EQ-5D. It adds important information on HRQL in food allergic adults. We found that the restrictions imposed on the patients due to the diet had the largest negative impact on HRQL. Both severity of the food allergy and the presence of concomitant allergic disorders had a profound impact on HRQL

Health-related quality of life in food hypersensitive schoolchildren and their families: parents' perceptions

BACKGROUND: About 20% of schoolchildren and adolescents in Sweden suffer from perceived food hypersensitivity (e.g. allergy or intolerance). Our knowledge of how child food hypersensitivity affects parents HRQL and what aspects of the hypersensitivity condition relate to HRQL deterioration in the family is limited. Thus the aim of this study was to investigate the parent-reported HRQL in families with a schoolchild considered to be food hypersensitive. The allergy-associated parameters we operated with were number of offending food items, adverse food reactions, additional hypersensitivity, allergic diseases and additional family members with food hypersensitivity. These parameters, along with age and gender were assessed in relation to child, parent and family HRQL. METHODS: In May 2004, a postal questionnaire was distributed to parents of 220 schoolchildren with parent-reported food hypersensitivity (response rate 74%). Two questionnaires were used: CHQ-PF28 and a study-specific questionnaire including questions on allergy-associated parameters. In order to find factors that predict impact on HRQL, stepwise multiple linear regression analyses were carried out. RESULTS: An important predictor of low HRQL was allergic disease (i.e. asthma, eczema, rhino conjunctivitis) in addition to food hypersensitivity. The higher the number of allergic diseases, the lower the physical HRQL for the child, the lower the parental HRQL and the more disruption in family activities. Male gender predicted lower physical HRQL than female gender. If the child had sibling(s) with food hypersensitivity this predicted lower psychosocial HRQL for the child and lower parental HRQL. Food-induced gastro-intestinal symptoms predicted lower parental HRQL while food-induced breathing difficulties predicted higher psychosocial HRQL for the child and enhanced HRQL with regards to the family's ability to get along. CONCLUSION: The variance in the child's physical HRQL was to a considerable extent explained by the presence of allergic disease. However, food hypersensitivity by itself was associated with deterioration of child's psychosocial HRQL, regardless of additional allergic disease. The results suggest that it is rather the risk of food reactions and measures to avoid them that are associated with lower HRQL than the clinical reactivity induced by food intake. Therefore, food hypersensitivity must be considered to have a strong psychosocial impact

Adolescents' experiences of being food-hypersensitive: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Experiencing or being at risk of adverse reactions to certain food items is a common health issue, especially among children and adolescents. Research has shown that living with the risk of food reactions and always having to take measures to avoid certain food in one's diet has a negative impact on quality of life. The aim of this study was to illuminate adolescents' experiences of being food hypersensitive.</p> <p>Methods</p> <p>Three focus group interviews and six individual interviews were carried out with all together 17 adolescents, 14–18 years of age, who had exclusion diets at school due to food hypersensitivity. The interviews were taped and transcribed verbatim and a qualitative content analysis was carried out.</p> <p>Results</p> <p>Five categories with subcategories, and one pervading theme, emerged. The categories were: <it>Perceiving oneself as being particular</it>, <it>Feeling constrained</it>, <it>Experiencing others' ignorance</it>, <it>Keeping control</it>, and <it>Feeling it's okay</it>. A pervading theme was conceptualised as <it>Striving to normalise the experience of being food-hypersensitive</it>. The adolescents regarded themselves as competent and courageous, but also described how they avoided the extra attention it implied to ask for special food considerations taken into account. Their self-conceptions were probably essential for their management of and attitude toward the hypersensitivity condition. They felt deprived, and those at risk of severe food reactions experienced insecurity and fear. Feelings of being disregarded were expressed, as well as facing unreliability and a lack of understanding from others. The continual work of constant vigilance and decision-making was described as time-consuming and frustrating. However, the adolescents also experienced considerate and supportive surroundings and were at pains to tone down the negative experiences and consequences of being food-hypersensitive.</p> <p>Conclusion</p> <p>Food avoidance by itself, and not only the somatic food reactions, brings about consequences with significant impacts on adolescents' lives. The findings from this study have implications for all of those who deal with adolescents who are food-hypersensitive, and not only health professionals. A deeper insight into adolescents' experiences gives an understanding which can improve the care-givers' efforts.</p

Upplevd allergi och överkänslighet : särskilt födoämnesöverkänslighet och dess konsekvenser för barn, ungdomar och deras familjer

Bakgrund: Allergi och överkänslighet är växande hälsoproblem. Att leva med allergi påverkar individens fysiska och psykiska livskvalitet, arbetsliv och sociala liv. Denna avhandling fokuserar på barn och ungdomar med självrapporterade allergiassocierade manifestationer, dvs allergisjukdom eller överkänslighet mot specifika ämnen. Konsekvenser av födoämnesöverkänslighet för barn och deras familjer är en relativt outforskad hälsofråga. Det övergripande syftet var att beskriva konsekvenser av allergiassocierade manifestationer, särskilt födoämnesöverkänslighet, för barn, ungdomar och deras föräldrar. Urval: Studiepopulationen utgjordes av skolbarn och skolungdomar i Tyresö kommun i södra Stockholms län samt deras föräldrar. Metod: Avhandlingen består av fyra delstudier. I Studie I distribuerades livskvalitetsinstrumentet SF-36 till 1488 ungdomar, 13-21 år, tillsammans med ett studiespecifikt frågeformulär med frågor om förekomst av allergiassocierade manifestationer. I Studie II genomfördes telefonintervjuer med föräldrarna till 230 barn, 6-18 år, med eliminationsdiet i skolan. I Studie III sändes en postenkät med livskvalitetsinstrumentet CHQ-PF28 och ett studiespecifikt frågeformulär till föräldrarna till 200 barn med eliminationsdiet i skolan. En regressionsanalys genomfördes för att undersöka vilka allergiassocierade variabler som kunde relateras till föräldrarnas rapporterade livskvalitet. Studie IV var en kvalitativ intervjustudie där 17 ungdomar, 14-19 år, intervjuades antingen i fokusgrupper eller individuellt om sina erfarenheter av att leva med födoämnesöverkänslighet. Resultat: Sextiofyra procent av ungdomarna rapporterade någon form av allergiassocierad manifestation: 46% angav överkänslighet mot specifika ämnen, 51% rapporterade någon allergisk sjukdom (astma, eksem, rinit). Ungdomarna med allergiassocierade manifestationer rapporterade signifikant sämre hälsorelaterad livskvalitet i sju av åtta SF-36-skalor jämfört med ungdomar utan sådana manifestationer, oavsett om överkänsligheten var diagnostiserad som allergi eller ej (I). För 85% av barnen med eliminationsdiet i skolan hade man konsulterat vården för födoämnesrelaterade besvär och 68% hade blivit diagnostiserade av läkare som födoämnesöverkänsliga. Barnen med vårdkontakter hade mer komplexa och allvarligare problem jämfört med de som inte konsulterat vården. Oavsett om man hade konsulterat vården eller ej, så var barnens födoämnesrelaterade besvär konsistenta med födoämnesöverkänslighet (II). Astma, eksem och rinit hade en betydande påverkan på det födoämnesöverkänsliga barnets fysiska livskvalitet. Födoämnesinducerade magbesvär hade negativ påverkan på föräldrarnas känslor medan födoämnesinducerade andningssvårigheter hade positiv inverkan på familjesammanhållningen (III). Genom kvalitativ innehållsanalys av de transkriberade intervjuerna identifierades fem huvudkategorier: Uppfatta sig som särskiljd , Känna sig begränsad, Uppleva andras okunskap, Hålla koll samt Det är okey. Ett genomgående tema identifierades som Strävan efter att normalisera erfarenheterna av att vara födoämnesöverkänslig . Slutsatser: Förekomsten av självrapporterade allergiassocierade manifestationer är omfattande. Födoämnesöverkänslighet är ett hälsoproblem med stark psykosocial påverkan på individen och samtidig allergisjukdom ökar denna påfrestning. Den unga människans biopsykosociala identitet som födoämnesöverkänslig påverkar hur hon hanterar sin födoämnesöverkänslighet. Processen att undvika farliga födoämnen kan sannolikt underlättas genom förbättrat strukturellt stöd och ökad kunskap hos och förståelse från omgivningen

Risk factors associated with incidence and persistence of frequent headaches

OBJECTIVE: Headaches represent a significant public health problem, but the knowledge of factors specifically related to incidence and persistence of headaches is still limited. The aim of this study was to evaluate whether gender, self-reported bruxism and variations in the dental occlusion contribute to onset and persistence of frequent headaches. MATERIALS AND METHODS: The study population comprised 280 dental students, examined annually in a 2-year prospective study with a questionnaire and a clinical examination of the jaw function. In the analysis subjects were dichotomized into cases with frequent (once a week or more) or without frequent headaches (controls). The 2-year cumulative incidence was based on subjects without frequent headaches at baseline. Cases with 2-year persistent headaches reported such symptoms at all three examinations. Self-reported bruxism and factors in the dental occlusion at baseline were used as independent variables in logistic regression analyses. RESULTS: The 2-year cumulative incidence of frequent headaches was 21%. Female gender (OR = 2.6; CI = 1.3-5.4), self-reported bruxism (OR = 2.3; CI = 1.2-4.4) and mandibular instability in intercuspal position (OR = 3.2; CI = 1.4-7.5) were associated with incidence of frequent headaches. Persistent headaches during the observation period were present in 12 individuals (4%) and significantly related to mandibular instability in intercuspal position (OR = 6.1; CI = 1.6-22.6). CONCLUSIONS: The results indicate that female gender, self-reported bruxism and mandibular instability in intercuspal position are of importance in the development of frequent headaches. In management of these patients a multidisciplinary approach including dentists may be important and, thus, advocated

Pain and Disability in the Jaw and Neck Region following Whiplash Trauma

The relationship between whiplash trauma and chronic orofacial pain is unclear, especially with regard to the time elapsed from trauma to development of orofacial pain. The aim was to analyze prevalence of jaw pain and disability, as well as the relationship between pain and disability in the jaw and neck regions in the early nonchronic stage after whiplash trauma. In this case-control study, 70 individuals (40 women, 30 men, mean age 35.5 y) who visited an emergency department with neck pain following a car accident were examined within 3 wk of trauma (group 1) and compared with 70 individuals (42 women, 28 men, mean age 33.8 y), who declined to attend a clinical examination but agreed to fill in questionnaires (group 2). The 2 case groups were compared with a matched control group of 70 individuals (42 women, 28 men, mean age 37.6 y) without a history of neck trauma. All participants completed questionnaires regarding jaw pain and dysfunction, rating pain intensity in jaw and neck regions on the Numerical Rating Scale, the Neck Disability Index, and Jaw Disability Checklist. Compared with controls, individuals with a recent whiplash trauma reported more jaw pain and dysfunction. Furthermore, there was a moderate positive correlation between jaw and neck pain ratings for group 1 (r = 0.61, P < 0.0001) and group 2 (r = 0.59, P < 0.0001). In the logistic regression analysis, cases showed higher odds ratios (range, 6.1 to 40.8) for jaw and neck pain and disability compared with controls. Taken together, the results show that individuals with a recent whiplash trauma report more jaw pain and disability compared with controls without a history of neck trauma. Furthermore, the correlation between jaw and neck pain intensity implies that intensity of neck pain in the acute stage after whiplash trauma might be a possible risk factor also for development of chronic orofacial pain