Adolescents with peanut allergies have heterogeneous experiences

The substantial heterogeneity in the experiences of adolescent patients with peanut allergies indicates that shared decision-making is important for optimizing outcomes and improving quality of life, according to a presentation.

“Living with peanut allergy presents day-to-day concerns and challenges for allergic individuals and their families that can negatively impact health-related quality of life,” William A. McCann, MD, vice president and chief medical officer of Allergy Partners PA in Asheville, North Carolina, said during the American College of Asthma, Allergy & Immunology Annual Scientific Meeting.

Approximately 2.2% of children and adolescents in the United States have peanut allergy, according to the researchers, yet literature about their quality of life has been limited.

The researchers designed the Peanut Allergy Burden Study (PABS) to assess the real-world burden of peanut allergy and identify potential predictors of Pediatric Quality of Life Inventory (PedsQL) scores after accounting for other covariates.

This study provided “a unique opportunity to assess which factors seem to be more frequently associated with higher or lower quality of life in this patient population,” McCann said.

The analysis included adolescents aged 13 to 17 years with self-reported peanut allergy diagnosed by a health care provider. To be eligible for the study, participants had to have experienced a reaction to peanuts that required medication or medical care, or they had ready access to emergency medication in case of an allergic reaction to peanuts. Additionally, the participants must have “completely” or “very much” agreed with the statement, “I avoid being around peanuts. I don’t eat peanuts, things made with peanuts, or peanut oil or other things that might have touched peanuts or peanut oil.”

The eligible participants completed a survey that collected demographic, medical and treatment information and the PedsQL 4.0 teen report, a validated, health-related quality-of-life assessment consisting of 23 items across physical, emotional, social, school and psychosocial domains. With a total score ranging from zero to 100, higher scores indicate higher or better self-reported quality of life.

“Given the large amount of information that was collected within the PABS survey, we felt this was a pretty unique opportunity to investigate which particular factors if any appear to be more closely associated with higher or lower PedsQL scores,” McCann said.

The researchers selected 102 participants (mean age, 14.7 years; 55.9% male; 62.8% white) for analysis. Their mean PedsQL total score was 69.4 (standard deviation, 23), whereas a comparable general population cohort reported a mean total score of 83.6 (standard deviation, 13.3).

The researchers conducted a univariate qualitative assessment of approximately 170 potential variables to determine if there were any associations between response values in those variables and PedsQL total scores reported by each patient. Next, the researchers narrowed this list to 25 variables that had at least weak correlation with PedsQL total score.

Following stepwise regression, the researchers narrowed the list to six items to include in their model: race, avoiding peanuts, history of moderate or severe reactions in the previous 12 months, satisfaction with prophylaxis, touching peanuts as the most common cause of most severe reactions and fear of experiencing a reaction.

The researchers were interested in specific variables, however, so they added four variables back to the model: patient age, patient sex, number of comorbid allergic conditions and level of agreement in daily life limitations due to allergy.

“We added those variables back to the model to have a final multivariate model looking at the relationship of each variable to the PedsQL total score after accounting for the impact of those other covariates,” McCann said. “This same model was then run for each of the domain scores to identify potential relationships between those variables and domain scores as well.

“Within this final model of 10 variables, there are three that seem to be associated with PedsQL total score,” McCann said. These included touching peanuts being the cause of severe reactions, complete agreement with avoiding peanuts and not very much or no satisfaction with prophylaxis.

The researchers also noted that even though they identified different potential variables that could have explained the variability associated with patient-reported PedsQL scores, they only accounted for about a third of all the variability observed in those results.

The study, then, “highlights the heterogeneity associated with this condition and how patients view their own allergies and how they manage them,” McCann said.