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Background: Food allergy (FA) is a common chronic condition among U.S. children. Children with FA and their families often report greater psychosocial burden, which is adversely impacted by the inability to participate in daily activities. Regularly attending school remains central to supporting the well-being of children with FAs and related academic success. Objective: The objective was to estimate the frequency of FA-related school absences, determine predictors, and understand how report of such absences is associated with FA-related psychosocial burden. Methods: A survey was administered to a nationally representative sample of U.S. households in 2015-2016, obtaining parent-proxy responses for 38,408 children. Prevalence estimates were based on responses from NORC's AmeriSpeak Panel (51% completion rate), which were augmented by nonprobability-based responses via calibration weighting to increase precision. Prevalence was estimated via weighted proportions. Multiple logistic regression models evaluated factors associated with FA-related missed school days. Results: Thirty-seven percent of children with FA who attended school in the past 12 months reportedly had one or more FA-related absence, with 13% missing 1-2 days (95% confidence interval [CI], 11.41-15.49 days), 17% missing 3-7 days (95% CI, 6.82-10.91 days), and 4% missing 8-14 days (95% CI, 3.13-6.20 days). Hispanic children were more likely to report missed school days in the past 12 months compared with white, non-Hispanic children with FA (odds ratio [OR] 1.62 [95% CI, 1.16-2.26]). Children with multiple FAs (OR 1.35 [95% CI, 1.03-1.76]), history of epinephrine use (OR 2.22 [95% CI, 1.70-2.90]), and anaphylaxis (OR 1.64 [95% CI, 1.26-2.14]) in the past 12 months, and those with a current epinephrine prescription (OR 1.05 [95% CI, 0.075-1.47]) have greater odds of reported FA-related school absence. Report of one or more FA-related absences was also associated with greater FA-related psychosocial burden (OR 1.72 [95% CI, 1.46-2.01]). Conclusion: Parent report of children missing school for reasons related to FA is remarkably common and associated with greater FA-related psychosocial burden.
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Food Allergy (FA) is a growing global public health concern. In the United States alone, 8% of children and 11% of adults have a convincing FA (symptoms consistent with an IgE-mediated reaction to a specific allergen). Given the significant prevalence of this condition, the objective of this mini-review is to illustrate the many dimensions of life that are impacted among those with FA. Summarizing findings from a breadth of current literature, we present how FA affects social, psychological, and economic-related quality of life. With this informative review, we endeavor to bring increased awareness to these issues and help cultivate a better future for individuals with FA.
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BACKGROUND: Introducing peanut products early can prevent peanut allergy (PA). The "Addendum guidelines for the prevention of PA in the United States" (PPA guidelines) recommend early introduction of peanut products to low and moderate risk infants and evaluation prior to starting peanut products for infants at high risk for PA (those with severe eczema and/or egg allergy). Rapid adoption of guidelines could aid in lowering the prevalence of PA. The Intervention to Reduce Early (Peanut) Allergy in Children (iREACH) trial was designed to promote PPA guideline adherence by pediatric clinicians. METHODS: A two-arm, cluster-randomized, controlled clinical trial was designed to measure the effectiveness of an intervention that included clinician education and accompanying clinical decision support tools integrated in electronic health records (EHR) versus standard care. Randomization was at the practice level (n = 30). Primary aims evaluated over an 18-month trial period assess adherence to the PPA guidelines using EHR documentation at 4- and 6-month well-child care visits aided by natural language processing. A secondary aim will evaluate the effectiveness in decreasing the incidence of PA by age 2.5 years using EHR documentation and caregiver surveys. The unit of observation for evaluations are individual children with clustering at the practice level. CONCLUSION: Application of this intervention has the potential to inform the development of strategies to speed implementation of PPA guidelines.
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Hipersensibilidad al Huevo , Hipersensibilidad al Cacahuete , Niño , Preescolar , Humanos , Lactante , Arachis , Inmunoglobulina E , Hipersensibilidad al Cacahuete/epidemiología , Hipersensibilidad al Cacahuete/prevención & control , Estados UnidosRESUMEN
Patient-reported outcomes (PROs) are measures of patients' health that are conveyed directly by individual patients. These measures serve as instruments to evaluate the impact of interventions on any aspect of patients' health, from specific symptoms to broader quality of life indicators. However, their effectiveness relies on capturing relevant factors accurately. Whereas they are commonly used in clinical trials, PROs extend their influence across health care settings, informing clinicians, health care payers, regulators, and administrators to guide quality improvement and reimbursement decisions. Neglecting health equity considerations in PRO development and implementation widens health disparities, leading to biased interpretations, medical mismanagement, and poor health outcomes among marginalized groups. To foster equitable health care, efforts must focus on considering the values of underrepresented populations in PRO design, addressing barriers to completion, enhancing representation in research, providing cultural competency training for clinicians, and allocating research funding to support health equity research. By addressing these issues, advances can be made toward fostering inclusive, equitable health care for all individuals.
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BACKGROUND: Experiencing food allergies and food insecurity has been linked to socioeconomic, physical, and mental health-related challenges, but less is known about the intersection of these experiences. This study aims to better understand the impact of food insecurity on food allergy patients and their caregivers, with the intention of informing ongoing efforts to improve screening for food insecurity and mental health concerns and reducing their burden among households managing food allergy. METHOD: As part of a community needs assessment, a cross-sectional survey was administered to a large, national sample (N=5,940) of US households with at least one food-allergic individual, The Hunger Vital Sign was utilized to assess food insecurity, the Patient Health Questionnaire (PHQ-4) and Food Allergy Independent Measure (FAIM) were leveraged to measure psychosocial outcomes. RESULTS: Among respondents, 69.9% screened at-risk of food insecurity on the Hunger Vital Sign, while 5.6% reported very low food security. Both adults and children with food allergy (FA) from households at risk for food insecurity were more likely to report FA-related anxiety, anger, loneliness, fear of eating, and bullying victimization than their counterparts from households not at risk of food insecurity (p < .0001 for all). Among these specific experiences, FA-related anxiety was the most common (25.4%/30.1% of children/adults). Perceived risk of food allergy-related fatality was positively associated with food insecurity status. CONCLUSION: Individuals with food allergies who are concomitantly experiencing food insecurity are at greater risk of a variety of mental health concerns, including those specific to food allergy as well as more general anxiety and depressive symptoms.
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Hipersensibilidad a los Alimentos , Inseguridad Alimentaria , Humanos , Hipersensibilidad a los Alimentos/psicología , Estudios Transversales , Femenino , Masculino , Adulto , Persona de Mediana Edad , Niño , Adolescente , Encuestas y Cuestionarios , Estados Unidos , Ansiedad/epidemiología , Composición Familiar , Cuidadores/psicología , Salud Mental , Adulto JovenRESUMEN
This article explores the multifaceted approach of food allergy (FA) advocacy, research, and education to address the diverse challenges associated with FA, such as disparities in socioeconomic status, food security, quality of life, and the overall burden of the disease. Advocacy initiatives are instrumental in driving policy changes, raising public awareness, and directing substantial research funding, with a focus on reducing disparities. They have influenced allergen labeling regulations and improved access to epinephrine, emphasizing the importance of school-based management plans, especially in underserved communities. Research in FA informs medical practices and offers them hope for improved treatments. Recent breakthroughs in peanut allergy prevention and oral immunotherapy trials exemplify the potential for advancements while highlighting the need to address disparities in health care access. Education is a critical tool for prevention, raising awareness, and reducing the risk of allergic reactions. Efforts should be tailored to reach marginalized communities, particularly in schools where education on FA management is essential. Collaborating directly with communities is imperative to ensure inclusivity and address disparities. Barriers such as mistrust, language and cultural differences, and lack of diversity among researchers must be overcome to encourage diverse participation in research studies. This article concludes by emphasizing the significance of a comprehensive approach to FA research that prioritizes equity and inclusivity. The call to action highlights the need for global initiatives to reshape the landscape of FA care and address disparities in health care access and outcomes.