Perceived allergy and hypersensitivity – especially food hypersensitivity – and the consequences for children, adolescents and their families

Background: Allergy and hypersensitivity are growing health issues with impact on the individual’s physical and psychosocial quality of life, work and social life. This thesis focuses on children and adolescents with self-reported allergy-associated conditions, i.e. allergic diseases or hypersensitivity to defined substances. Research about the consequences of food hypersensitivity for children and their families are scarce. Therefore, the overall aim was to describe consequences of allergy-associated conditions, especially food hypersensitivity, for children, adolescents and their parents. The study populations consisted of children and adolescents in Tyresö, a municipality in the south of Stockholm, and their parents.

Methods: The thesis consists of four studies. In Study I the health-related quality-of-life (HRQL) instrument SF-36 was distributed to 1488 adolescents, 13-21 years, together with a study-specific questionnaire including questions about the occurrence of allergy-associated conditions. In Study II telephone interviews were conducted with the parents of 230 schoolchildren, 6-18 years, with exclusion diets at school. In Study III a postal questionnaire, including the HRQL instrument CHQ-PF28 and a study-specific questionnaire, was distributed to the parents of 200 children with exclusion diets at school. A regression analysis of parent-reported data was performed to examine which allergy-associated parameters that could be related to the parents’ reported quality of life. Study IV was a qualitative interview study. Seventeen adolescents, 14-19 years, were interviewed about their experiences of being food hypersensitive, either in focus groups or by means of individual interviews. A qualitative content analysis of the transcribed interviews was carried out.

Results: Sixty four per cent of the adolescents reported some type of allergy-associated condition: 46% reported hypersensitivity to defined substances, 51% reported allergic disease. Adolescents with allergy-associated conditions reported significantly lower HRQL in seven of the eight SF-36 scales compared to adolescents without such conditions, regardless of whether the condition had been doctor-diagnosed or not (I). For 85% of the children with exclusion diets at school, the parents had consulted health-care professionals for food related problems. 68% were doctor-diagnosed as having food hypersensitivity. Those who had consulted health-care professionals had more complex and severe problems compared to those who had not. Regardless of whether the children had consulted health-care professionals, their food-related problems were consistent with food hypersensitivity (II). Asthma, eczema and rhinitis had a considerable impact on the food hypersensitive child’s physical quality of life. Food-induced gastro-intestinal symptoms had a negative impact on parents’ emotional state while food-induced breathing difficulties had a positive impact on families ability to get along (III).The qualitative content analysis of the transcribed interviews identified five categories: Perceiving oneself as being particular, Feeling constrained, Experiencing others’ ignorance, Keeping control and Feeling it’s okay. A pervading theme was conceptualised as ”Striving to normalise the experience of being food hypersensitive”.

Conclusions: The magnitude of self-reported allergy-associated conditions is extensive. Perceived food hypersensitivity has a significant psychosocial impact and comorbidity involving allergic diseases increases the burden for the individual. The young individual’s bio psychosocial identities of being food hypersensitive have an impact on how they manage their hypersensitivity. The process of avoiding unsafe foods can probably be made easier by supplying better structural support and increased understanding from others.

List of scientific papers

I. Marklund B, Ahlstedt S, Nordstrom G. (2004). Health-related quality of life among adolescents with allergy-like conditions - with emphasis on food hypersensitivity. Health Qual Life Outcomes. 2:65.
https://pubmed.ncbi.nlm.nih.gov/15555064

II. Gunnarsson N, Marklund B, Ahlstedt S, Borell L, Nordström G. (2005). Allergy-like conditions and health-care contacts among children with exclusion diets at school. Scand J Caring Sci. 19(1):46-52.
https://pubmed.ncbi.nlm.nih.gov/15737165

III. Marklund B, Ahlstedt S, Nordström G. (2006). Health-related quality of life in food hypersensitive schoolchildren and their families: parents perceptions. Health Qual Life Outcomes. 4:48.
https://pubmed.ncbi.nlm.nih.gov/16901348

IV. Marklund B, Wilde-Larsson B, Ahlstedt S, Nordstrom G. (2007). Adolescents experiences of being food-hypersensitive: a qualitative study. BMC Nurs. 6(1):8.
https://pubmed.ncbi.nlm.nih.gov/17922926

V. Marklund B., Ahlstedt S., Nordström G. (2007). Food hypersensitivity and quality of life. Curr Opin Allergy Clin Immunol. 7(3):279-87.
https://doi.org/10.1097/ACI.0b013e32814a569b