Current Allergy and Asthma Reports

, Volume 13, Issue 6, pp 651–661 | Cite as

Food Allergy and Quality of Life: What Have We Learned?

  • Jantina L. van der VeldeEmail author
  • Anthony E. J. Dubois
  • Bertine M. J. Flokstra-de Blok


Health-related quality of life (HRQL) has become an emerging focus of interest in food allergy. Food allergy is a disease characterized by low mortality and symptoms which only occur during an allergic reaction. However, food-allergic patients continuously need to be alert when eating in order to prevent potentially severe allergic reactions, which may be fatal. Fear of such reactions and the need to be continuously vigilant may seriously compromise their HRQL. During the last decade, numerous studies have been published on food allergy and HRQL. The development of reliable, valid and responsive instruments for measuring HRQL in food allergic patients has facilitated this research even further. Such instruments have given insight into the specific problems a patient may face and the impact of food allergy-related interventions from the patient’s perspective. This paper focuses on the most significant findings regarding this topic since its first appearance in the literature in 2000.


Food allergy Health-related quality of life HRQL Interventions 



Double-blind placebo-controlled food challenge


Food Allergy Independent Measure Questionnaire


Food Allergy Impact Scale


Food Allergy Parent-Questionnaire


Food Allergy Quality of Life Questionnaire-Child Form, -Teenager Form, -Adult Form, -Parent Form (0–12 years), and -Parent Form Teenagers (13–17 years)


Food Allergy Quality of Life–Parental Burden Questionnaire


Food Allergy Quality of Life Questionnaire for Teenagers


Food Hypersensitivity Family Impact Questionnaire


Health-related quality of life


Minimal important difference


Pediatric Food Allergy–Quality of Life questionnaire


Quality of Life


Compliance with Ethics Guidelines

Conflict of Interest

Jantina L.van der Velde, Anthony E.J. Dubois, and Bertine M.J. Flokstra-de Blok declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with animal subjects performed by any of the authors. With regard to the authors’ research cited in this paper, all procedures were followed in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000 and 2008.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Sicherer SH, Munoz-Furlong A, Godbold JH, Sampson HA. US prevalence of self-reported peanut, tree nut, and sesame allergy: 11-year follow-up. J Allergy Clin Immunol. 2010;125:1322–6.Google Scholar
  2. 2.
    •• Baptist AP, Dever SI, Greenhawt MJ, Polmear-Swendris N, McMorris MS, Clark NM. A self-regulation intervention can improve quality of life for families with food allergy. J Allergy Clin Immunol. 2012;130:263–5.e6. This study illustrates that an educational program for food allergy based on the principles of self regulation improves quality of life for parents of children with food allergy.PubMedCrossRefGoogle Scholar
  3. 3.
    Boden SR, Wesley Burks A. Anaphylaxis: a history with emphasis on food allergy. Immunol Rev. 2011;242:247–57.PubMedCrossRefGoogle Scholar
  4. 4.
    Flokstra-de Blok BM, DunnGalvin A, Vlieg-Boerstra BJ, Oude Elberink JN, Duiverman EJ, Hourihane JO, et al. Development and validation of the self-administered Food Allergy Quality of Life Questionnaire for adolescents. J Allergy Clin Immunol. 2008;122:139–44. 144.e1-2.PubMedCrossRefGoogle Scholar
  5. 5.
    Flokstra-de Blok BM, van der Meulen GN, DunnGalvin A, Vlieg-Boerstra BJ, Oude Elberink JN, Duiverman EJ, et al. Development and validation of the Food Allergy Quality of Life Questionnaire - Adult Form. Allergy. 2009;64:1209–17.PubMedCrossRefGoogle Scholar
  6. 6.
    Avery NJ, King RM, Knight S, Hourihane JO. Assessment of quality of life in children with peanut allergy. Pediatr Allergy Immunol. 2003;14:378–82.PubMedCrossRefGoogle Scholar
  7. 7.
    Cummings AJ, Knibb RC, King RM, Lucas JS. The psychosocial impact of food allergy and food hypersensitivity in children, adolescents and their families: a review. Allergy. 2010;65:933–45.PubMedCrossRefGoogle Scholar
  8. 8.
    Bollinger ME, Dahlquist LM, Mudd K, Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol. 2006;96:415–21.PubMedCrossRefGoogle Scholar
  9. 9.
    DunnGalvin A, de BlokFlokstra BM, Burks AW, Dubois AE, Hourihane JO. Food allergy QoL questionnaire for children aged 0-12 years: content, construct, and cross-cultural validity. Clin Exp Allergy. 2008;38:977–86.PubMedCrossRefGoogle Scholar
  10. 10.
    Flokstra-de Blok BM, DunnGalvin A, Vlieg-Boerstra BJ, Oude Elberink JN, Duiverman EJ, Hourihane JO, et al. Development and validation of a self-administered Food Allergy Quality of Life Questionnaire for children. Clin Exp Allergy. 2009;39:127–37.PubMedCrossRefGoogle Scholar
  11. 11.
    Cohen BL, Noone S, Munoz-Furlong A, Sicherer SH. Development of a questionnaire to measure quality of life in families with a child with food allergy. J Allergy Clin Immunol. 2004;114:1159–63.PubMedCrossRefGoogle Scholar
  12. 12.
    • Mackenzie H, Roberts G, Van Laar D, Dean T. A new quality of life scale for teenagers with food hypersensitivity. Pediatr Allergy Immunol. 2012;23:404–11. This study describes the development and evaluation of a new HRQL instrument for food-allergic adolescents in the UK (the "You and Your Food Allergy Scale"). Google Scholar
  13. 13.
    World Health Organisation. Constitution of the World Health Organisation. Handbook of Basic Documents. Geneva; 1948. pp. 3-20.Google Scholar
  14. 14.
    van der Velde JL. Chapter 1: general introduction. Figure 1. Thesis: Quality of life of food allergic patients. Ridderkerk; 2012. pp. 14.Google Scholar
  15. 15.
    Flokstra-de Blok BM, Dubois AE. Quality of life measures for food allergy. Clin Exp Allergy. 2012;42:1014–20.Google Scholar
  16. 16.
    Casebeer AL, Verhoef MJ. Combining qualitative and quantitative research methods: considering the possibilities for enhancing the study of chronic diseases. Chronic Dis Can. 1997;18:130–5.PubMedGoogle Scholar
  17. 17.
    Fayers PM, Machin D. Quality of life : the assessment, analysis and interpretation of patient-reported outcomes. 2nd ed. Wiley: Chichester etc.; 2007.Google Scholar
  18. 18.
    Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med. 1993;118:622–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Riley AW. Evidence that school-age children can self-report on their health. Ambul Pediatr. 2004;4:371–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Cremeens J, Eiser C, Blades M. Characteristics of health-related self-report measures for children aged three to eight years: a review of the literature. Qual Life Res. 2006;15:739–54.PubMedCrossRefGoogle Scholar
  21. 21.
    Connolly MA, Johnson JA. Measuring quality of life in paediatric patients. Pharmacoeconomics. 1999;16:605–25.PubMedCrossRefGoogle Scholar
  22. 22.
    Smith H. Differing views of children and parents: some cautionary tales! Clin Exp Allergy. 2011;41:1344–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Juniper EF, Guyatt GH, Jaeschke R. How to develop and validate a new health-related quality of life instrument. In: Anonymous Spilker B, editor. Quality of life and pharmacoeconimcs in clinical trials. Philadelphia: Lippincott-Raven Publishers; 1996. p. 49–56.Google Scholar
  24. 24.
    Juniper EF, Guyatt GH, Streiner DL, King DR. Clinical impact versus factor analysis for quality of life questionnaire construction. J Clin Epidemiol. 1997;50:233–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Testa MA, Simonson DC. Assesment of quality-of-life outcomes. N Engl J Med. 1996;334:835–40.PubMedCrossRefGoogle Scholar
  26. 26.
    van der Velde JL, Flokstra-de Blok BM, Vlieg-Boerstra BJ, Oude Elberink JN, Schouten JP, Dunngalvin A, et al. Test-retest reliability of the Food Allergy Quality of Life Questionnaires (FAQLQ) for children, adolescents and adults. Qual Life Res. 2009;18:245–51.PubMedCrossRefGoogle Scholar
  27. 27.
    •• van der Velde JL, Flokstra-de Blok BM, de Groot H, Oude-Elberink JN, Kerkhof M, Duiverman EJ, et al. Food allergy-related quality of life after double-blind, placebo-controlled food challenges in adults, adolescents, and children. J Allergy Clin Immunol. 2012;130:1136–1143.e2. This study supports the responsiveness and longitudinal validity of the FAQLQ-CF, -TF and -AF. Additionally, this study illustrates the impact of a DBPCFC from the patient’s perspective. Google Scholar
  28. 28.
    Juniper EF, Guyatt GH, Willan A, Griffith LE. Determining a minimal important change in a disease-specific Quality of Life Questionnaire. J Clin Epidemiol. 1994;47:81–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. Control Clin Trials. 1991;12:142S–58S.PubMedCrossRefGoogle Scholar
  30. 30.
    Oude Elberink JN, de Monchy JG, Golden DB, Brouwer JL, Guyatt GH, Dubois AE. Development and validation of a health-related quality-of-life questionnaire in patients with yellow jacket allergy. J Allergy Clin Immunol. 2002;109:162–70.PubMedCrossRefGoogle Scholar
  31. 31.
    •• DunnGalvin A, Cullinane C, Daly DA, Flokstra-de Blok BM, Dubois AE, Hourihane JO. Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire - Parent Form in children 0-12 years following positive and negative food challenges. Clin Exp Allergy. 2010;40:476–85. This study supports the responsiveness and validity of the FAQLQ-PF and illustrates that parent-reported HRQL of food-allergic children (0–12 years) improves following a food challenge.PubMedCrossRefGoogle Scholar
  32. 32.
    Resnick ES, Pieretti MM, Maloney J, Noone S, Munoz-Furlong A, Sicherer SH. Development of a questionnaire to measure quality of life in adolescents with food allergy: the FAQL-teen. Ann Allergy Asthma Immunol. 2010;105:364–8.PubMedCrossRefGoogle Scholar
  33. 33.
    World Health Organization. Process of translation and adaptation of instruments. In: 2008.
  34. 34.
    Lebovidge JS, Stone KD, Twarog FJ, Raiselis SW, Kalish LA, Bailey EP, et al. Development of a preliminary questionnaire to assess parental response to children's food allergies. Ann Allergy Asthma Immunol. 2006;96:472–7.PubMedCrossRefGoogle Scholar
  35. 35.
    • Mikkelsen A, Borres MP, Bjorkelund C, Lissner L, Oxelmark L. The Food hypersensitivity famiLy ImPact (FLIP) questionnaire - development and first results. Pediatr Allergy Immunol. 2013;24:574–81. This study describes the development and first results on the validity of the newest HRQL instrument for food allergy, the food hypersensitivity family impact questionnaire (FLIP).PubMedCrossRefGoogle Scholar
  36. 36.
    Knibb RC, Stalker C. Validation of the Food Allergy Quality of Life-Parental Burden Questionnaire in the UK. Qual Life Res. 2013;22:1841–9.PubMedCrossRefGoogle Scholar
  37. 37.
    •• Knibb RC, Ibrahim NF, Stiefel G, Petley R, Cummings AJ, King RM, et al. The psychological impact of diagnostic food challenges to confirm the resolution of peanut or tree nut allergy. Clin Exp Allergy. 2012;42:451–9. This study supports the responsiveness of the FAQL-PB. Additionally, this study illustrates the positive impact of a food challenge on HRQL of mothers of food-allergic children.PubMedCrossRefGoogle Scholar
  38. 38.
    Hamp N, Hourihane J, Knibb RC, Dubois AEJ, Flokstra-de Blok BMJ, DunnGalvin A. Developmental specificity and sensitivity between two age appropriate Health-Related Quality of Life measures in food allergic children and teenagers. J Allergy Clin Immunol. 2008;121:S107.CrossRefGoogle Scholar
  39. 39.
    • van der Velde JL, Flokstra-de Blok BM, Hamp A, Knibb RC, Duiverman EJ, Dubois AE. Adolescent-parent disagreement on health-related quality of life of food-allergic adolescents: who makes the difference? Allergy. 2011;66:1580–9. This study illustrates that there is disagreement between parent and adolescent reports on the HRQL of food-allergic adolescents.PubMedCrossRefGoogle Scholar
  40. 40.
    • Knibb RC, Ibrahim NF, Petley R, Cummings AJ, King RM, Roberts G, et al. Validation of the Paediatric Food Allergy Quality of Life Questionnaire (PFA-QL). Pediatr Allergy Immunol. 2013;24:288–92. This study describes the cross-sectional validity and internal reliability of the previously developed PFA-QL, an instrument to measure parent- and child-reported HRQL of food-allergic children.PubMedCrossRefGoogle Scholar
  41. 41.
    Primeau MN, Kagan R, Joseph L, Lim H, Dufresne C, Duffy C, et al. The psychological burden of peanut allergy as perceived by adults with peanut allergy and the parents of peanut-allergic children. Clin Exp Allergy. 2000;30:1135–43.PubMedCrossRefGoogle Scholar
  42. 42.
    Sicherer SH, Noone SA, Munoz-Furlong A. The impact of childhood food allergy on quality of life. Ann Allergy Asthma Immunol. 2001;87:461–4.PubMedCrossRefGoogle Scholar
  43. 43.
    Marklund B, Ahlstedt S, Nordstrom G. Health-related quality of life among adolescents with allergy-like conditions - with emphasis on food hypersensitivity. Health Qual Life Outcomes. 2004;2:65.PubMedCrossRefGoogle Scholar
  44. 44.
    Calsbeek H, Rijken M, Bekkers MJ, Kerssens JJ, Dekker J, van Berge Henegouwen GP. Social position of adolescents with chronic digestive disorders. Eur J Gastroenterol Hepatol. 2002;14:543–9.PubMedCrossRefGoogle Scholar
  45. 45.
    Teufel M, Biedermann T, Rapps N, Hausteiner C, Henningsen P, Enck P, et al. Psychological burden of food allergy. World J Gastroenterol. 2007;13:3456–65.PubMedGoogle Scholar
  46. 46.
    Lieberman JA, Weiss C, Furlong TJ, Sicherer M, Sicherer SH. Bullying among pediatric patients with food allergy. Ann Allergy Asthma Immunol. 2010;105:282–6.PubMedCrossRefGoogle Scholar
  47. 47.
    Flokstra-de Blok BM, van der Velde JL, Vlieg-Boerstra BJ, Oude Elberink JN, Dunngalvin A, Hourihane JO, Duiverman EJ, Dubois AE. Health-related quality of life of food allergic patients measured with generic and disease-specific questionnaires. Allergy. 2010;65:1031–8.Google Scholar
  48. 48.
    • van der Velde JL, Flokstra-de Blok BM, Dunngalvin A, Hourihane JO, Duiverman EJ, Dubois AE. Parents report better health-related quality of life for their food-allergic children than children themselves. Clin Exp Allergy. 2011;41:1431–39. This study illustrates that parents of food-allergic children aged 8–12 years report better HRQL for their food-allergic children than children themselves. Google Scholar
  49. 49.
    Buyan N, Turkmen MA, Bilge I, Baskin E, Haberal M, Bilginer Y, et al. Quality of life in children with chronic kidney disease (with child and parent assessments). Pediatr Nephrol. 2010;25:1487–96.PubMedCrossRefGoogle Scholar
  50. 50.
    Marklund B, Ahlstedt S, Nordstrom G. Health-related quality of life in food hypersensitive schoolchildren and their families: parents' perceptions. Health Qual Life Outcomes. 2006;4:48.PubMedCrossRefGoogle Scholar
  51. 51.
    Wassenberg J, Cochard MM, Dunngalvin A, Ballabeni P, Flokstra-de Blok BM, Newman CJ, Hofer M, Eigenmann PA. Parent perceived quality of life is age-dependent in children with food allergy. Pediatr Allergy Immunol. 2012;23:412–9.Google Scholar
  52. 52.
    DunnGalvin A, Hourihane JO, Frewer L, Knibb RC, Oude Elberink JN, Klinge I. Incorporating a gender dimension in food allergy research: a review. Allergy. 2006;61:1336–43.PubMedCrossRefGoogle Scholar
  53. 53.
    Pinczower GD, Bertalli NA, Bussmann N, Hamidon M, Allen KJ, DunnGalvin A, et al. The effect of provision of an adrenaline autoinjector on quality of life in children with food allergy. J Allergy Clin Immunol. 2013;131:238–40.e1.PubMedCrossRefGoogle Scholar
  54. 54.
    van der Velde JL, Flokstra-de Blok BM, Vlieg-Boerstra BJ, Oude Elberink JN, DunnGalvin A, Hourihane JO, et al. Development, validity and reliability of the food allergy independent measure (FAIM). Allergy. 2010;65:630–5.PubMedCrossRefGoogle Scholar
  55. 55.
    Acquadro C, Conway K, Hareendran A, Aaronson N. European Regulatory Issues and Quality of Life Assessment (ERIQA) Group. Literature review of methods to translate health-related quality of life questionnaires for use in multinational clinical trials. Value Health. 2008;11:509–21.PubMedCrossRefGoogle Scholar
  56. 56.
    Gjersing L, Caplehorn JR, Clausen T. Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Med Res Methodol. 2010;10:13.PubMedCrossRefGoogle Scholar
  57. 57.
    • Goossens NJ, Flokstra-de Blok BM, Vlieg-Boerstra BJ, Duiverman EJ, Weiss CC, Furlong TJ, et al. Online version of the food allergy quality of life questionnaire-adult form: validity, feasibility and cross-cultural comparison. Clin Exp Allergy. 2011;41:574–81. This study describes the cross-cultural validity of the FAQLQ-AF in the USA and illustrates that American food-allergic adults report worse HRQL than Dutch food-allergic adults.PubMedCrossRefGoogle Scholar
  58. 58.
    Marklund B, Ahlstedt S, Nordstrom G. Food hypersensitivity and quality of life. Curr Opin Allergy Clin Immunol. 2007;7:279–87.PubMedCrossRefGoogle Scholar
  59. 59.
    Vlieg-Boerstra BJ, Duiverman EJ, van der Heide S, Bijleveld CM, Kukler J, Dubois AE. Should children with a history of anaphylaxis to foods undergo challenge testing? Clin Exp Allergy. 2008;38:1935–42.PubMedCrossRefGoogle Scholar
  60. 60.
    Kemp AS, Allen CW, Campbell DE. Parental perceptions in egg allergy: does egg challenge make a difference? Pediatr Allergy Immunol. 2009;20:648–53.PubMedCrossRefGoogle Scholar
  61. 61.
    Nguyen M, Wainstein BK, Hu W, Ziegler JB. Parental satisfaction with oral peanut food challenges; perception of outcomes and impact on management of peanut allergy. Pediatr Allergy Immunol. 2010;21:1119–26.PubMedCrossRefGoogle Scholar
  62. 62.
    Strinnholm A, Brulin C, Lindh V. Experiences of double-blind, placebo-controlled food challenges (DBPCFC): a qualitative analysis of mothers' experiences. J Child Health Care. 2010;14:179–88.PubMedCrossRefGoogle Scholar
  63. 63.
    Zijlstra WT, Flinterman AE, Soeters L, Knulst AC, Sinnema G, L'Hoir MP, et al. Parental anxiety before and after food challenges in children with suspected peanut and hazelnut allergy. Pediatr Allergy Immunol. 2010;21:e439–45.PubMedCrossRefGoogle Scholar
  64. 64.
    Barnes ML, Ward JH, Fardon TC, Lipworth BJ. Effects of levocetirizine as add-on therapy to fluticasone in seasonal allergic rhinitis. Clin Exp Allergy. 2006;36:676–84.PubMedCrossRefGoogle Scholar
  65. 65.
    Bisgaard H, Zielen S, Garcia-Garcia ML, Johnston SL, Gilles L, Menten J, et al. Montelukast reduces asthma exacerbations in 2- to 5-year-old children with intermittent asthma. Am J Respir Crit Care Med. 2005;171:315–22.PubMedCrossRefGoogle Scholar
  66. 66.
    Humbert M, Beasley R, Ayres J, Slavin R, Hebert J, Bousquet J, et al. Benefits of omalizumab as add-on therapy in patients with severe persistent asthma who are inadequately controlled despite best available therapy (GINA 2002 step 4 treatment): INNOVATE. Allergy. 2005;60:309–16.PubMedCrossRefGoogle Scholar
  67. 67.
    Oude Elberink JN, De Monchy JG, Van Der Heide S, Guyatt GH, Dubois AE. Venom immunotherapy improves health-related quality of life in patients allergic to yellow jacket venom. J Allergy Clin Immunol. 2002;110:174–82.PubMedCrossRefGoogle Scholar
  68. 68.
    Beyer K. A European perspective on immunotherapy for food allergies. J Allergy Clin Immunol. 2012;129:1179–84.PubMedCrossRefGoogle Scholar
  69. 69.
    Oude Elberink J. Venom immunotherapy (VIT): clinical efficacy and improvement in quality of life. Drugs Today (Barc). 2008;44(Suppl B):43–5.Google Scholar
  70. 70.
    Finegold I, Dockhorn RJ, Ein D, Dolen WK, Oppenheimer J, Potter LH. Immunotherapy throughout the decades: from Noon to now. Ann Allergy Asthma Immunol. 2010;105:328–36.PubMedCrossRefGoogle Scholar
  71. 71.
    •• Factor JM, Mendelson L, Lee J, Nouman G, Lester MR. Effect of oral immunotherapy to peanut on food-specific quality of life. Ann Allergy Asthma Immunol. 2012;109:348–352.e2. This study illustrates that oral immunotherapy improves HRQL of peanut-allergic children and teenagers (5–18 years).PubMedCrossRefGoogle Scholar
  72. 72.
    Carraro S, Frigo AC, Perin M, Stefani S, Cardarelli C, Bozzetto S, et al. Impact of oral immunotherapy on quality of life in children with cow milk allergy: a pilot study. Int J Immunopathol Pharmacol. 2012;25:793–8.PubMedGoogle Scholar
  73. 73.
    Goossens NJ, Flokstra-de Blok BM, van der Meulen GN, Botjes E, Burgerhof HG, Gupta RS, Springston EE, Smith B, Duiverman EJ, Dubois AE. Food allergy knowledge of parents - is ignorance bliss?. Pediatr Allergy Immunol. 2013;24:567–73.Google Scholar
  74. 74.
    Clark NM, Gong M, Kaciroti N. A model of self-regulation for control of chronic disease. Health Educ Behav. 2001;28:769–82.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jantina L. van der Velde
    • 1
    • 3
    Email author
  • Anthony E. J. Dubois
    • 2
    • 3
  • Bertine M. J. Flokstra-de Blok
    • 1
    • 3
  1. 1.University Medical Center Groningen, Department of General PracticeUniversity of GroningenGroningenThe Netherlands
  2. 2.University Medical Center Groningen, Department of Pediatrics, Division of Pediatric Pulmonology and Pediatric AllergyUniversity of GroningenGroningenThe Netherlands
  3. 3.University Medical Center Groningen, GRIAC Research InstituteUniversity of GroningenGroningenThe Netherlands

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