Different from intolerance and sensitivity, which are not immune mediated problems. Sometimes hard to tell the difference.
2 types of food allergy, you can have both at the same time – type 1 (IgE mediated), and non-type 1 (non-IgE mediated – possibly type 4 hypersensitivity).
Most commonly (in Scotland – but varies across UK, especially with different ethnic groups), and varies widely across the world):
- Tree nuts
- Various fruits
Hospital admissions for food allergy in the UK have been increasing for some time. If you ask people about their children’s allergies, up to 28% of infants will report allergies – real figure is probably between 1 and 4%. Lifetime and point prevalence of self-reported food allergy 20% and 13%, respectively – point prevalence of sensitization as assessed by sIgE stands at 17%, skin prick test 6%, and food challenge positivity 1%. Based on clinical history or positive food challenge, food allergies have increased from 2.6% in 2000–2012 to 3.5% in 2012–2021. Point prevalence for under 16s for self reported but physician diagnosed food allergy is 3.75%. Patterns vary across European regions but not in a consistent way. [Spolidoro and Venter 2022]
Having a child with a food allergy has a significant effect on the quality of life for the whole family. One study suggested that having a peanut allergic child had a worse effect on a family than having a child with diabetes, even though with diabetes you also have restrictions on eating and the potential for serious adverse events. A similar study found the same comparing food allergic families with families where a child had a rheumatological diagnosis. The main domains affected were social. Patient/parent feedback pretty consistent across the world however (although most studies done in Europe and English speaking countries), and across time:
- Parents lived in fear after the first reaction, often perceiving it as traumatic, and often feeling guilt too
- They tried to live an ordinary family life and had to learn how to be one-step ahead and understand early signs.
- The family’s social life was also influenced.
- Parents asked for support and information from health professionals
- More knowledge and skills increased parents’ confidence (and by implication quality of life – Knibb 2015)
Mothers tend to report greater impact on the child’s quality of life and experience more anxiety and stress than fathers. Mothers tend to shelter the child, whereas fathers more often express a desire to expand their child’s life, and these differences are often greater where parents are separated.
The concern for the child’s safety affected eating outside the home, with birthday parties and visits to peers’ homes particularly threatening. School and nursery are a major source of concern and often led to more parental work, preparing safe lunches.
Parents often felt they had to teach themselves about allergies, due to the lack of early information provided by health care, and then ended up having to teach family, friends and educational institutions too.
Adolescence is a particularly stressful time, as parents recognize the need for the child to become more independent, at the same time that the adolescent can see the parents as excessively controlling (at least with respect to peanut allergy). Supportive friends particularly important for adolescents.
[Larsen Moen, J Ped Nursing 2019]