Study Identifies Household Food Allergen Exclusion Practices, Psychosocial Impacts

Hana B. Ruran

Credit: LinkedIn

The most common food allergies are to peanut, tree nut, and egg, recent findings suggest, and parents who decide to exclude food from the home due to their child’s allergy report worse mean allergy-related life quality scores for anxiety.¹

These and other related findings resulted from a recent analysis conducted to look into the proportion of households electing to exclude allergens by specific allergies to foods and related assessments of psychosocial function. This study’s team of investigators was led by Hana B. Ruran, an MD candidate from the division of immunology at Boston Children’s Hospital.

Ruran and colleagues highlighted the quality of life impacts of food allergies on households, noting allergy’s effect on stress and related concerns regarding accidental exposure to allergens and emergency treatment.²

“Some parents manage their child’s [food allergy] by excluding allergens from their home,” Ruran et al. wrote. “We sought to determine the proportion of households excluding allergens by specific [food allergy] and its association with this practice and [food allergy]-related psychosocial functioning.”¹

Trial Design Details

The investigative team carried out their cross-sectional study during which a set of validated surveys were provided to families of children with health care clinician–diagnosed food allergies anonymously. These data were drawn from Boston Children’s Hospital and from various outlets on social media from April 2022 - November 2023.

The team utilized logistic regression with generalized estimating equations for the purposes of addressing the subjects and comparing the household food exclusion practices based on specific food allergies. Psychosocial distinctions between the households assessed that excluded allergenic foods and those that did not were analyzed, with investigators determining statistical significance to be a 2-sided P-value threshold of less than .05.

Within 39 states in the US and Canada, there were 919 surveys distributed to and then collected from parents of children known to have food allergies. The research team found that among those who responded, 96.6% had been mothers.

The team highlighted that the median age of the children evaluated had been 6 years (interquartile range [IQR], 3.0-9.0 years) and the median age of parents evaluated had been 39 years (IQR, 36.0-43.0 years). In terms of racial categories, 85.5% of respondents were labeled as White and 2.5% as Black.

The investigators found that 63.3% of parents reported excluding at least a single allergenic food from their home as a result of their child’s allergies. Among the children assessed in this analysis, it was reported that 57.6% had been male , 78.6% had been White, and 3.2% had been Black.’

Notable Findings on Households

After their evaluation of these households, the investigative team found that the most commonly-described allergies to foods were peanuts among 67.8%, tree nuts among 65.5%, and eggs among 44.0%.

In the team’s predefined analyses, it was noted that the most commonly excluded food had been peanuts for 62.4% of these households, followed by tree nuts at 54.7%. The next most commonly-excluded was sesame among 51.3%, contrasting notably with the only 24.3% of households that both reported egg allergy and excluded the allergen from their homes.

Notably, the exclusion rate for sesame was significantly higher compared to exclusions for egg, milk, soy, and wheat.

The investigators found that parents who did not include allergenic foods in their households reported poorer food allergy-associated quality of life scores. This pattern was shown to have persisted across various child age subgroups.

Raised generalized anxiety scores were also found to be more common among children in the age range of 8 - 17 years living in households with allergenic food exclusions, based upon findings from a parent-proxy screener for child anxiety disorders. The score elevations were noted by the research team among 30.4% of the children in the exclusionary households, as opposed to only 15.6% of those in households that did not use such exclusions (P = .03).

“Our study is limited by its cross-sectional design and causality between psychosocial well-being and excluding allergens from the home cannot be determined and may not represent the broader [food allergy] population,” they wrote. “Future studies are needed to determine the causes of psychosocial distress in families who exclude [food allergy] from the home and how the psychosocial well-being of families of children with [food allergy] can be improved.”¹

References

1. ^{Ruran HB, D’Ambrosi G, Dupuis R, et al. Household Food Allergen Exclusion Practices and Food Allergy-Related Psychosocial Functioning. JAMA Netw Open. 2024;7(12):e2452646. doi:10.1001/jamanetworkopen.2024.52646.}
2. ^{Bingemann TA, LeBovidge J, Bartnikas L, Protudjer JLP, Herbert LJ. Psychosocial impact of food allergy on children and adults and practical interventions. Curr Allergy Asthma Rep. 2024;24(3):107-119. doi:10.1007/s11882-023-01121-x.}