Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Food allergy: Impact on health-related quality of life

Sally A Noone, RN, MSN
Section Editor
Scott H Sicherer, MD, FAAAAI
Deputy Editor
Elizabeth TePas, MD, MS


Approximately 8 percent of children and up to 5 percent of adults in the United States are affected by food allergy [1]. Food-allergic reactions are the leading cause of emergency department visits for anaphylaxis in the United States [2]. The only therapy for food allergy is emergency treatment in the case of an accidental exposure that triggers a reaction. The mainstay of management of food allergy is avoidance of the food(s) that causes the allergic reaction. Patients and families must be vigilant about food allergen avoidance in a variety of settings (eg, home, restaurants, schools, camps, social gatherings). The burden of avoidance and fear of an accidental exposure can increase anxiety and result in reduced health-related quality of life (HRQL) [3,4]. (See "Anaphylaxis: Emergency treatment" and "Prescribing epinephrine for anaphylaxis self-treatment" and "Management of food allergy: Avoidance" and "Food allergy in schools and camps".)

This topic reviews questionnaires used to measure HRQL and discusses the impact of food allergy on HRQL. A broader overview of HRQL assessment is discussed separately. (See "Evaluation of health-related quality of life (HRQL) in patients with a serious life-threatening illness".)


Quality of life (QOL) is defined by the World Health Organization (WHO) as "an individual's perception of his/her position of life in the context of the culture and value systems in which he/she lives and in relation to his/her goals, expectations, standards, and concerns" [5]. HRQL refers to a person's or group's perception of the effect of an illness and its therapy on their QOL and daily functioning. HRQL has three components: social, psychological, and physical. (See "Evaluation of health-related quality of life (HRQL) in patients with a serious life-threatening illness".)

Two types of instruments exist to measure HRQL: generic and disease specific [6-8]. Both questionnaires aim to measure impairments that patients or their families, rather than health professionals, consider important. Patients can have similar levels of clinical impairment and yet have widely different measures of HRQL.

Generic questionnaires are useful in comparing different diseases, and results may be compared with group norms. In addition, these questionnaires are sensitive to comorbidities. Generic instruments may miss small changes in a patient's impairment over time because they do not incorporate questions directly related to the specific disorder.

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Sep 2017. | This topic last updated: Aug 17, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Sicherer SH, Sampson HA. Food allergy: Epidemiology, pathogenesis, diagnosis, and treatment. J Allergy Clin Immunol 2014; 133:291.
  2. Sampson HA. Anaphylaxis and emergency treatment. Pediatrics 2003; 111:1601.
  3. 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.
  4. Ravid NL, Annunziato RA, Ambrose MA, et al. Mental health and quality-of-life concerns related to the burden of food allergy. Immunol Allergy Clin North Am 2012; 32:83.
  5. World Health Organization (WHO). Measurement of quality of life in children. Geneva: Division of mental health, 1993 (Report).
  6. de Blok BM, Vlieg-Boerstra BJ, Oude Elberink JN, et al. A framework for measuring the social impact of food allergy across Europe: a EuroPrevall state of the art paper. Allergy 2007; 62:733.
  7. Flokstra-de Blok BM, DunnGalvin A, Vlieg-Boerstra BJ, et al. Development and validation of a self-administered Food Allergy Quality of Life Questionnaire for children. Clin Exp Allergy 2009; 39:127.
  8. Flokstra-de Blok BM, van der Velde JL, Vlieg-Boerstra BJ, et al. Health-related quality of life of food allergic patients measured with generic and disease-specific questionnaires. Allergy 2010; 65:1031.
  9. Teufel M, Biedermann T, Rapps N, et al. Psychological burden of food allergy. World J Gastroenterol 2007; 13:3456.
  10. Klinnert MD, Robinson JL. Addressing the psychological needs of families of food-allergic children. Curr Allergy Asthma Rep 2008; 8:195.
  11. Valentine AZ, Knibb RC. Exploring quality of life in families of children living with and without a severe food allergy. Appetite 2011; 57:467.
  12. Primeau MN, Kagan R, Joseph L, 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.
  13. Sicherer SH, Noone SA, Muñoz-Furlong A. The impact of childhood food allergy on quality of life. Ann Allergy Asthma Immunol 2001; 87:461.
  14. Langraf J, Abetz L, Ware JE, Jr. The Child Health Questionnaire (CHQ). A User's Manual, 1st ed, The Health Institute, Boston 1996.
  15. Le TM, Lindner TM, Pasmans SG, et al. Reported food allergy to peanut, tree nuts and fruit: comparison of clinical manifestations, prescription of medication and impact on daily life. Allergy 2008; 63:910.
  16. Salvilla SA, Dubois AE, Flokstra-de Blok BM, et al. Disease-specific health-related quality of life instruments for IgE-mediated food allergy. Allergy 2014; 69:834.
  17. Muraro A, Dubois AE, DunnGalvin A, et al. EAACI Food Allergy and Anaphylaxis Guidelines. Food allergy health-related quality of life measures. Allergy 2014; 69:845.
  18. Cohen BL, Noone S, Muñoz-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.
  19. Springston EE, Smith B, Shulruff J, et al. Variations in quality of life among caregivers of food allergic children. Ann Allergy Asthma Immunol 2010; 105:287.
  20. Knibb RC, Stalker C. Validation of the Food Allergy Quality of Life-Parental Burden Questionnaire in the UK. Qual Life Res 2013; 22:1841.
  21. Baptist AP, Dever SI, Greenhawt MJ, et al. A self-regulation intervention can improve quality of life for families with food allergy. J Allergy Clin Immunol 2012; 130:263.
  22. Greenhawt M, Schultz F, DunnGalvin A. A validated index to measure health-related quality of life in patients with food protein-induced enterocolitis syndrome. J Allergy Clin Immunol 2016; 137:1251.
  23. Bollinger ME, Dahlquist LM, Mudd K, et al. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol 2006; 96:415.
  24. Cortes A, Castillo A, Sciaraffia A. Development of the scale of psychosocial factors in food allergy (SPS-FA). Pediatr Allergy Immunol 2013; 24:671.
  25. Lebovidge JS, Stone KD, Twarog FJ, et al. Development of a preliminary questionnaire to assess parental response to children's food allergies. Ann Allergy Asthma Immunol 2006; 96:472.
  26. DunnGalvin A, de BlokFlokstra BM, Burks AW, et al. Food allergy QoL questionnaire for children aged 0-12 years: content, construct, and cross-cultural validity. Clin Exp Allergy 2008; 38:977.
  27. DunnGalvin A, Cullinane C, Daly DA, et al. 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.
  28. Gupta RS, Kim JS, Barnathan JA, et al. Food allergy knowledge, attitudes and beliefs: focus groups of parents, physicians and the general public. BMC Pediatr 2008; 8:36.
  29. Gupta RS, Kim JS, Springston EE, et al. Development of the Chicago Food Allergy Research Surveys: assessing knowledge, attitudes, and beliefs of parents, physicians, and the general public. BMC Health Serv Res 2009; 9:142.
  30. Gupta RS, Kim JS, Springston EE, et al. Food allergy knowledge, attitudes, and beliefs in the United States. Ann Allergy Asthma Immunol 2009; 103:43.
  31. Gupta RS, Springston EE, Kim JS, et al. Food allergy knowledge, attitudes, and beliefs of primary care physicians. Pediatrics 2010; 125:126.
  32. Gupta RS, Springston EE, Smith B, et al. Food allergy knowledge, attitudes, and beliefs of parents with food-allergic children in the United States. Pediatr Allergy Immunol 2010; 21:927.
  33. Lieberman JA, Weiss C, Furlong TJ, et al. Bullying among pediatric patients with food allergy. Ann Allergy Asthma Immunol 2010; 105:282.
  34. Avery NJ, King RM, Knight S, Hourihane JO. Assessment of quality of life in children with peanut allergy. Pediatr Allergy Immunol 2003; 14:378.
  35. King RM, Knibb RC, Hourihane JO. Impact of peanut allergy on quality of life, stress and anxiety in the family. Allergy 2009; 64:461.
  36. Cummings AJ, Knibb RC, Erlewyn-Lajeunesse M, et al. Management of nut allergy influences quality of life and anxiety in children and their mothers. Pediatr Allergy Immunol 2010; 21:586.
  37. Knibb RC, Ibrahim NF, Petley R, et al. Validation of the Paediatric Food Allergy Quality of Life Questionnaire (PFA-QL). Pediatr Allergy Immunol 2013; 24:288.
  38. Akeson N, Worth A, Sheikh A. The psychosocial impact of anaphylaxis on young people and their parents. Clin Exp Allergy 2007; 37:1213.
  39. Lyons AC, Forde EM. Food allergy in young adults: perceptions and psychological effects. J Health Psychol 2004; 9:497.
  40. Sampson MA, Muñoz-Furlong A, Sicherer SH. Risk-taking and coping strategies of adolescents and young adults with food allergy. J Allergy Clin Immunol 2006; 117:1440.
  41. Bock SA, Muñoz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 2001; 107:191.
  42. Resnick ES, Pieretti MM, Maloney J, et al. Development of a questionnaire to measure quality of life in adolescents with food allergy: the FAQL-teen. Ann Allergy Asthma Immunol 2010; 105:364.
  43. Flokstra-de Blok BM, van der Meulen GN, DunnGalvin A, et al. Development and validation of the Food Allergy Quality of Life Questionnaire - Adult Form. Allergy 2009; 64:1209.
  44. Goossens NJ, Flokstra-de Blok BM, Vlieg-Boerstra BJ, 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.