Mothers of children with food allergies report poorer perceived life status which may be explained by limited career choices.

Pediatric food allergy is associated with direct, indirect and intangible costs. However, it remains unclear if intangible costs of pediatric food allergy influence parental career choices. Using data from 63 parents whose children had been diagnosed by a pediatric allergist with food allergy, we sought to (a) establish perceived life status of families with a food allergic child, and (b) to describe any career limitations viewed as attributable to food allergy. Compared to responding parents whose children had one to two food allergies, those with three or more food allergies had significantly poorer perceived life status (ß - 0.74; 95%CI - 1.41; - 0.07; p < 0.05). Overall, 14.3% of parents (all mothers) reported career limitations due to food allergy. Two of the 7 mothers (28.6%) who reported career limitations due to their child's food allergy fell below Statistics Canada cut-off for low-income, after tax dollars (LIM-AT). One of the three mothers who had changed jobs because of their child's food allergy was below the LIM-AT. No fathers reported food allergy-related career limitations. In conclusion, mothers of children with multiple food allergies reported worse perceived life status that may be partly explained by food allergy-related career limitations.

GRAded oral challenge for Drug allergy Evaluation-Delabelling described through families' voices.

BACKGROUND: Children are often diagnosed with an antibiotic allergy, with little investigation to confirm whether it is a true allergy. Recent studies support the use of oral challenges to confirm antibiotic allergy. Yet, little is known about families' perceptions of these challenges, or experiences of living with a misdiagnosis, often for many years. OBJECTIVE: To describe how families with a child previously labelled as "antibiotic allergic," but who has subsequently been delabelled, perceive the experience of misdiagnosis and subsequent delabelling. METHODS: We performed semi-structured interviews with parents whose children had recently completed a graded oral challenge for antibiotic allergy. Interview transcripts were analysed concurrently, but independently, by two investigators, using content analysis. RESULTS: A total of 15 parents (14 individual interviews; 1 mother-father dyad) participated. Children were, on average, 5.04 ± 4.5 years and were first diagnosed in infancy (mean age: 1.82 ± 1.48 years) subsequent to a rash (14/14; 100%), and commonly at a walk-in clinic (6/14; 42.9%). We identified four themes: (1) A red, raised rash results in a quick diagnosis despite a lack of testing, (2) sensitive care allays concerns, (3) delabelling brings relief, but also mystery and calls for proper diagnoses, and (4) quick diagnoses are reckless, but manageable through downward comparisons. CONCLUSION AND CLINICAL RELEVANCE: These findings underscore the importance of a careful physical examination and clinical history of the patient, but also an ongoing dialogue to support families, both of which would ideally begin at the time of initial investigation.

Milk allergy most burdensome in multi-food allergic children.

BACKGROUND: Food allergy is a substantial health burden, which disproportionately affects children. Among children with food allergy, as many as 70% have multiple food allergies. Whereas the overall burden of food allergy on quality of life has been described, little is known about the burden of individual allergens. We aimed to examine the perception of burden among families with multiple food-allergic children. METHODS: Parents of children with 1 + children with multiple food allergies including milk responded to online questions, including both open-ended and closed-ended questions on food allergy-related burdens of time, financial costs, social restrictions, and emotional demands. RESULTS: Overall, 64 children (69.8% boys) of whom (73.0%) most were aged 10 and younger were included. Most had been diagnosed with food allergy in infancy and by a (pediatric) allergist. Other common allergies included peanut (65.6%), tree nuts (57.8%), egg (76.6%), and sesame (31.3%). Quantitatively, milk allergy was reported as carrying the most burden, including most socially limiting (81.5%), requiring the most planning (75.9%), causing the most anxiety (68.5%), most challenging to find "safe" or allergy-friendly foods (72.2%), and costly (81.5%). Qualitatively, we identified five themes that captured burdens associated with costs, marketing of milk products to children, risk of cross-contamination, ubiquity of milk/dairy and public confusion with lactose intolerance, and an unwillingness of others to accommodate the allergy. CONCLUSION: Parents whose children have multiple food allergies, including milk, report milk as the allergy associated with the greatest time, financial, social, and emotional burdens.

Billing fees for various common allergy tests vary widely across Canada.

BACKGROUND: The prevalence of food allergy in Canada is high and has increased over time. To date, there are no Canadian data on the healthcare costs of visits to allergists. METHODS: We sent an anonymous survey to allergist members of the Canadian Society of Allergy and Clinical Immunology (CSACI) between October and December 2019. Survey questions included demographic information and billing fees for various types of allergy visits and diagnostic testing. RESULTS: Of 200 allergists who are members of CSACI, 43 allergists responded (21.5% response rate). Billing fees varied widely. The greatest ranges were noted for oral immunotherapy (OIT; both initial consultation [mean $198.70; range $0 to $575] and follow up/build up visits [mean $125.74; range: $0 to $575]). There were significant provincial differences in billing fees, as well as significant billing fee differences between hospital versus community allergists (e.g. oral food challenge [OFC]: $256.38 vs. $134.94, p < 0.01). Billing fees were higher outside of Ontario, with the exception of specific Immunoglubulin E (sIgE) testing and OIT visits. CONCLUSIONS: Greater standardization of billing fees across provinces and between hospital versus community allergy could result in more consistency of billing fees for OFC and OIT across Canada. Further knowledge of exact costs will help inform practice and policy in the diagnosis and management of food allergy.

Pediatric food allergy-related household costs are influenced by age, but not disease severity.

OBJECTIVE: The economic burden of food allergy on households is poorly understood. We evaluated the household costs associated with specialist-diagnosed pediatric food allergy, with focus on age and disease severity. STUDY DESIGN: A cross-sectional study of 70 Swedish case-control pairs (59% boys) was conducted using Food Allergy Economic questionnaire. Household costs were analyzed between age- and gender-matched cases (children aged 0-17 years, with specialist-diagnosed food allergy) and controls (non-food allergic households). RESULTS: Parents were predominantly university-educated and employed full-time. Most cases had parent-reported previous anaphylaxis. Mean total annual household costs were comparable between cases and controls. However, compared to controls, cases had significantly higher direct medical-, and non-medical related costs; higher indirect medical-related costs, and higher intangible costs (all p < 0.05). In a sensitivity analyses of only cases aged 0-12 years, direct household costs, including lost earnings due to child's hospitalization, were significantly higher than controls. Results from only children with severe disease paralleled those of all cases vs. controls. CONCLUSIONS: Although pediatric food allergy is not associated with higher total annual household costs, these households have significantly higher direct medical-related, indirect and intangible costs vs. non-food allergic households. Higher household costs were identified amongst younger children, but not disease severity.

Maternal food allergy is associated with daughters' menarche in early adolescence.

RATIONALE: Associations between allergic disease and puberty amongst females have been widely studied. However, this association has received less attention in multigenerational populations. To this end, we sought to examine maternal allergic disease status ever, and daughters' menarche. METHODS: In a cohort of children born in 1995, in Manitoba, Canada, we considered maternal allergic disease ever to daughters' age 7-8 years, and daughters' menarche at ages 12-14 years. We included all participants for whom we had information on both the exposure and the outcome of those eligible. Data were analysed using descriptive statistics and logistic regression, with adjustment for confounding variables. RESULTS: Overall, the prevalences of maternal allergic diseases were 28.6% for asthma 18.8% for food allergy, 27.3% for eczema and 45.5% for rhinitis. By age 12-14 years, 41.6% (64/159) girls had reached menarche. Maternal food allergy was significantly associated with daughters' menarche (OR 4.39, 95% CI 1.51-12.73), whereas no association was found for maternal asthma, eczema or rhinitis. With consideration to comorbid disease, a combination of maternal asthma + food allergy was associated with daughters' menarche by age 12-14 years (OR 6.41; 95% CI 1.32-31.01). CONCLUSIONS: Maternal food allergy ever is associated with daughters' menarche by age 12-14 years.

Food allergy-related concerns during the transition to self-management.

BACKGROUND: Compared to non-allergic individuals, food allergic individuals have impaired health-related quality of life (HRQL). However, effects of gender and age are unclear. The objective of our study was to describe associations between allergies to common foods and HRQL with consideration to gender and age. METHODS: Adolescents and adults (N = 137; 49.6% males) with specialist-diagnosed allergy to milk, egg and/or wheat completed age-appropriate versions of the Food Allergy Quality of Life Questionnaire (FAQLQ). We pooled common questions and calculated overall- and domain-specific HRQL in association with number and severity of symptoms and time elapse since worst reaction. RESULTS: In the entire study population, HRQL was not affected by gender or age, whereas gender-specific age categories affected HRQL among males only. For example, males 18-39 years had worse overall- (ß = 0.77; 95% CI 0.08-1.45) and domain-specific HRQL vs. males < 18 years. Among participants with 1-3 food allergy symptoms, no associations were found. Among participants with 4-6 symptoms, the domain allergen avoidance and dietary restrictions was worse among older participants (e.g. 40+ years: ß = 0.71; 95% CI 0.05-1.37 vs. < 18 years), and males 18-39 vs. < 18 years. Among participants with severe symptoms, females vs. males, and participants 18-39 vs. < 18 years had worse HRQL. At least 4 years since worst reaction was associated with worse HRQL for participants 40+ years vs. < 18 years, and older males vs. males < 18 years. Nearly all differences exceeded the clinical relevance threshold of ≥ 0.5. CONCLUSIONS: Associations between allergies to common foods and HRQL are affected by gender and age. Most affected are males 18-39 years. Among females, HRQL is more stable across age groups.

Impaired health-related quality of life in adolescents with allergy to staple foods.

BACKGROUND: Cow's milk, hen's egg and wheat are staple foods in a typical western diet. Despite the ubiquity of these foods, the impact of staple food allergy on health-related quality of life (HRQL) amongst adolescents is incompletely understood. The aims of this study were to make use of the Swedish version of EuroPrevall's disease-specific food allergy quality of life questionnaire-teenager form (FAQLQ-TF) and to investigate the association between objectively-diagnosed staple food allergy and HRQL amongst adolescents. METHODS: In this cross-sectional study, 58 adolescents aged 13-17 years [n = 40 (69 %) boys] with objectively-diagnosed allergy to the staple foods cow's milk, hen's egg and/or wheat and living in Stockholm, Sweden were included. Adolescents completed the FAQLQ-TF, which has a corresponding scale of 1 = best HRQL, and 7 = worst HRQL. Overall HRQL and domain-specific HRQL were established. Adolescents also reported symptoms, adrenaline auto injector (AAI) prescription and presence of other food allergies. A history of anaphylaxis was defined among those reporting difficulty breathing, inability to stand/collapse, and/or loss of consciousness. Clinically different HRQL was set at a mean difference of ≥0.5. RESULTS: Overall mean HRQL was poorer than average [mean: 4.70/7.00 (95 % CI 4.30-5.01)]. The domain risk of accidental exposure was significantly associated with clinically better HRQL than the domain allergen avoidance and dietary restrictions (mean difference = 0.76; p < 0.001). Girls had clinically worse, but not statistically significantly different mean HRQL than boys (mean difference = 0.71; p < 0.07). HRQL tended to be worse amongst those with allergies to more than three foods or an AAI prescription. The number and types of symptoms, including a history of anaphylaxis were not associated with worse HRQL. CONCLUSIONS: As ascertained via a food allergy-specific questionnaire, adolescents with staple food allergy report poorer than average HRQL, specifically in relation to emerging independence and the need for support. Girls have clinically worse HRQL than boys. The number and type of previous symptoms and history of anaphylaxis were not associated with worse HRQL.

The influence of childhood asthma on puberty and height in Swedish adolescents.

BACKGROUND: Evidence relating to the effect of asthma on puberty or height is inconclusive. We aimed to examine whether the exposure of childhood asthma, including timing and phenotypes, and inhaled corticosteroid (ICS) use is either cross-sectionally or longitudinally associated with the outcomes of pubertal staging or height. METHODS: This study employed data from a longitudinal, population-based cohort of Swedish children (born 1994-1996). At ages 1, 2, 4, 8, and 12 years, parent-reported data on asthma and ICS use in the previous 12 months were collected. At 8 and 12 years, height was ascertained at a clinical visit, and child-reported, respectively. At 12 years, children answered puberty-related questions. RESULTS: Retention through 12 years was 82% (3366/4089). Participants without puberty data (n = 620) were excluded, yielding a study population of 2746 (67%). Asthma at 8 years, including timing of onset and phenotypes, was not statistically significantly associated with pubertal staging in adjusted models. Children with asthma averaged 0.93 cm (95% CI 0.35-1.50) shorter than children without asthma. Children with asthma using ICS were 1.28 (95% CI 0.62-1.95) shorter than those with asthma without using ICS. CONCLUSIONS: We found no consistent association between asthma and pubertal staging. Children with asthma were shorter than those without asthma. Moreover, children with asthma using ICS were shorter than those not using ICS.

Knowledge and use of folic acid in women of reproductive age.

Folic acid reduces the risk of neural tube defects. As approximately 50% of pregnancies are unintended, women of reproductive age should be aware of the importance of folic acid. We reviewed the existing literature on these women's knowledge of folic acid and neural tube defects. Databases searched were PubMed, CINAHL, and Health Reference Center Academic. We used terms such as "folic acid knowledge" and "folic acid awareness" to search articles published from 1998 to 2010. Awareness of the benefits of folic acid before conception and during pregnancy was low, although knowledge levels were associated with education and household income. Women who were already knowledgeable about folic acid cited health care professionals, magazines and newspapers, and radio and television as common sources of information. Effective knowledge translation is needed to ensure that women are informed about the benefits of folic acid during the reproductive years. This knowledge will allow them to make informed decisions about folic acid consumption. Health care professionals play an influential role in promoting folic acid knowledge among women of childbearing age. Lower levels of knowledge among women with lower levels of education and/or household income must be addressed.

Weight status and determinants of health in Manitoba children and youth.

PURPOSE: Because of the tremendous increase in overweight and obesity in Canadian children and youth in recent decades, we examined associations among health determinants, healthy living characteristics, and overweight and obesity in Manitoba children and youth. METHODS: Using descriptive statistics and logistic regression, we identified factors associated with measured overweight and obesity in a sample of 1651 Manitoba children and youth aged two to 17 years from the 2004 Canadian Community Health Survey 2.2-Nutrition. RESULTS: Thirty-one percent of the children and youth were overweight or obese. Males aged 12 to 17 or from food-insecure homes were more likely to be overweight or obese than were younger males or males from food-secure households. Females from households with higher parental education were less likely to be overweight or obese than were those from households with lower parental education. Female youth who were sedentary for at least three hours daily were more likely to be overweight or obese than were less sedentary female youth. A trend toward significance with overweight or obesity in youth was noted with levels of daily fruit and vegetable consumption and regular physical activity. CONCLUSIONS: Overweight and obesity in Manitoba children and youth are associated with socio-economic and demographic characteristics, and with food and activity behaviours. These findings can inform health and nutrition policy and practice by indicating health inequities that require particular attention.

Children's perceptions of healthful eating and physical activity.

PURPOSE: Healthful lifestyle habits established in childhood may continue through adulthood. Such habits may also be effective in preventing or reversing overweight and obesity. However, little is known about children's perceptions of healthful eating and physical activity. Thus, we sought a better understanding of how children perceive healthful eating and physical activity. METHODS: A purposeful selection was made of Winnipeg, Manitoba, boys (n=23) and girls (n=22) aged 11 to 12 years. The children were interviewed using a semi-structured, in-depth interview guide. Data were analyzed using thematic coding. RESULTS: Although healthful eating was seen as necessary for health, high-fat, high-sugar foods were a source of pleasure and enjoyed during social times. Physical activity was a way of spending time with friends, either through active play or watching sports. Boys viewed screen time and homework as barriers to physical activity, while girls identified no common barriers. Children viewed physical activity as easier than healthful eating, describing the former as "play" and "fun." CONCLUSIONS: Knowing how children think about food choices will further our understanding of the disconnect between nutrition knowledge and dietary behaviours. Understanding conflicting pressures that influence children's healthful lifestyles may enhance communication about these topics among parents, educators, and children.