Girls, women with food allergy report lower health-related quality of life
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Key takeaways:
- Differences in baseline self-reported health-related quality of life between sexes persisted regardless of age.
- Caregiver sex did not impact proxy-reported quality of life.
Girls and women with food allergy reported lower baseline health-related quality of life than boys and men, according to a review published in Clinical & Experimental Allergy.
However, the sex of caregivers did not impact the proxy-reported quality of life of children, Sophie A. Rosser, MS, PhD candidate, and Mimi Tang, PhD, group leader, allergy immunology, Murdoch Children’s Research Institute, and colleagues wrote.
“We know that the greatest impact of food allergy for patients and their families is a reduced health-related quality of life,” Rosser and Tang told Healio in a joint statement.
Although there has been lots of consumer advocacy for better recognition of quality of life in the food allergy space, they continued, research exploring whether and how patient demographic factors, especially sex, might affect quality of life has been limited.
“We thought investigating this gap would have a real benefit for the food allergy community and future food allergy research design,” they said.
Review design, results
The authors systematically searched Medline and Embase on April 4, 2022, with an updated search that also included APA PsycINFO on Dec. 5, 2023, yielding 34 studies that included food allergy, sex and health-related quality of life (HRQL).
The noninterventional studies found in the review provided evidence for poorer self-reported HRQL among female participants with food allergy compared with male participants with food allergy despite age.
In five of the six cross-sectional studies investigating adult HRQL, women had lower self-reported baseline total or sub-score HRQL than men. Also, girls had lower self-reported baseline HRQL scores than boys in five of eight studies.
However, the authors said, findings pertaining to affected HRQL sub-scores and between different HRQL in studies that included the self-reported HRQL of children varied.
Findings pertaining to dietary risk and emotional impact often indicated sex differences among studies that used Food Allergy Quality of Life Questionnaires (FAQLQ), the authors continued, with one study finding that females had clinically significantly poorer HRQL than males across all FAQLQ sub-scores.
The cumulative evidence for associations between child sex or caregiver sex and caregiver proxy-reported HRQL was limited, the authors said, with two of nine studies that included proxy-reported HRQL by child sex finding potentially poorer HRQL among girls compared with boys. The other seven studies found no difference.
There also were differences between boys and girls in changes in HRQL from baseline through follow-up in the interventional studies included the review, the authors said, but the presence and direction of these associations were not clear.
“There may also be gender differences in children’s health-related quality of life after immunotherapy, with some weak evidence suggesting that males may have greater quality of life improvement during treatment than females,” Rosser and Tang said.
Another study found that the association between sex and HRQL was strong across all
scores and measures, the authors said, with boys experiencing greater improvements in HRQL during follow-up than girls.
Two other studies found slightly poorer HRQL after follow-up for one sex, but they did not include a reference sex, so the authors said they could not determine the direction of this association.
One study did not find any difference in total HRQL scores between the sexes at any point in treatment, whether the HRQL was proxy-reported or self-reported, although there were lower self-reported emotional impact and proxy-reported food anxiety sub-scores during the induction of oral immunotherapy.
When one study investigated the use of exclusion diets as an intervention, it did not find any differences between boys and girls in HRQL.
None of the studies in the review found differences in the self-reported total HRQL of caregivers based on the sex of their children or on their own sex, the authors said, although there were potential associations in HRQL sub-scores among the caregivers.
There was a potential difference between the sexes in the emotional issues HRQL sub-score in one noninterventional study, the authors said, but the study did not define the reference child sex, so the direction of this association was unclear.
Also, two noninterventional studies of caregiver self-reported HRQL found that mothers had lower sub-scores related to dietary, social, well-being and physical factors than fathers.
The two interventional studies that observed caregiver HRQL did not report sub-scores, the authors said, adding that the limited data in the studies of caregiver HRQL left them unable to confirm any association between the child’s sex and caregiver HRQL.
Conclusions, next steps
Overall, the authors said, these findings indicate possible differences in self-reported baseline HRQL between males and females with food allergy as well as in changes in HRQL for children during immunotherapy and in HRQL sub-scores among caregivers.
Most often, the authors continued, girls and women had lower HRQL than boys and men, whether they were patients with food allergy or caregivers.
Based on these findings, the authors said that there is a complex relationship between sex and HRQL among populations with food allergy and that variations in HRQL instruments and narrow considerations of sex probably limit this relationship.
“These findings are significant because they suggest food allergy burden is experienced differently by different genders for both the patient and the caregiver,” Rosser and Tang said.
“This means we need to adopt a personalized medicine approach in allergy management that better accounts for gender, especially when caring for patients with food allergy and when conducting research into new food allergy treatments,” they continued.
Further, the authors said their findings may indicate that girls may need more support in managing the social, psychological and emotional aspects of their food allergy.
“Doctors should therefore be aware that more intensive clinical support is likely to be required for some patients and families with food allergy and be prepared to tailor their approach to meet individual needs,” Rosser and Tang said.
The authors also noted that immunotherapies for food allergens are still experimental treatments with many questions pertaining to efficacy and safety, especially regarding outcomes in specific patient sub-groups such as boys and girls.
“Our observation that girls may potentially experience less benefit from treatment emphasizes that doctors should also endeavor to ensure their knowledge regarding predictors of treatment outcomes is current so they can engage in appropriate shared decision-making with patients,” Rosser and Tang said.
The authors called for specific focus on sex in future investigations of HRQL, with purposeful measurement of the impact of sex on HRQL sub-scores, not just on total scores.
Studies also should account for the influence of gender roles in parenting, considering the primary roles that many women have in caregiving, in addition to genders outside of binary classifications, to help determine whether psychosocial experience or biological factors drive differences in food allergy outcomes, the authors said.
“Our findings have highlighted a need for further research into patient characteristics and their role in food allergy outcomes,” Rosser and Tang said.
In particular, the authors continued, researchers next need to look further into the mechanisms that determine food allergy-related quality of life to figure out whether biological or psychosocial characteristics have a stronger influence on patient and caregiver well-being.
“Our findings also highlight that more extensive and inclusive research is needed to understand the lived experience of food allergy, and we hope this piece of research will encourage others to consider this as well,” Rosser and Tang said.
Reference:
- Does gender affect food allergy’s impact on quality of life? https://www.eurekalert.org/news-releases/1033334. Published Feb. 7, 2024. Accessed Feb. 7, 2024.
For more information:
Sophie A. Rosser, MS, can be reached at Sophie.rosser@mcri.edu.au. Mimi Tang, PhD, can be reached at mimi.tang@mcri.edu.au.
Perspective
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Interestingly, the only study in this review without a critical or serious risk of bias indicated that boys experienced a greater HRQL improvement over the course of treatment than girls. However, no gender differences were observed during immunotherapy trials.
This review serves as a reminder that our patients represent a complex interconnection of socioeconomic, environmental, biological, psychological and cultural factors. Research questions and assessment tools need to evolve as our patients have so that clinicians are more suitably equipped to provide individualized diagnosis and treatment plans.
All but one of the studies used by the authors received serious or critical risk of bias ratings. The findings reported may conflate general quality-of-life differences with those that are distinctively food allergy related. Additional validated food allergy specific quality-of-life measurements are necessary to accurately determine whether a true association exists between gender identities, biological sex and health-related quality of life for people who have food allergies as well as their caregivers.
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