The Psychosocial Burden of Food Allergy Among Adults: A US Population-Based Study

Abstract

Background: Food allergy (FA) affects >25 million US adults, resulting in substantial health care utilization. Data suggest that patients with FA suffer impairments in FA-related quality of life (FAQoL); however, little is known regarding psychosocial impacts of FA among US adults.

Objective: To characterize FAQoL among a large, nationally representative adult sample, and its determinants, including sociodemographic characteristics, severity, comorbid conditions, allergic symptoms, number and type of allergens, and health care utilization.

Methods: A survey was administered between October 2015 and September 2016 to a nationally representative sample of US households. Survey constructs included the Food Allergy Independent Measure (FAIM), which was developed to quantify adverse impacts of living with FA on patient quality of life. FAIM responses were analyzed from adults reporting current FA (N = 6207). Linear regression models examined associations with sociodemographic and FA characteristics.

Results: The overall estimated mean FAIM score was 2.87 (95% confidence interval: 2.83-2.90). FAIM scores (range = 1-7) in adjusted models were invariant by race/ethnicity, private/public insurance status, and census division. Significant differences (P < .05) by lower household income, lower age, and greater education emerged, resulting in higher FAIM scores indicating FAQoL impairment. Among major food allergens, wheat, soy, and milk allergies were each associated with the greatest increases in adjusted FAIM scores. Reporting a current epinephrine autoinjector (EAI) prescription, severe allergic reaction history, history of EAI use, FA-related emergency department visits, or more FAs were also associated with significantly higher FAIM scores.

Conclusion: The population-level psychosocial burden of adults with FA is substantial, broadly distributed, and differs by demographic and allergic disease characteristics.

Keywords: Food allergy; Population health; Psychosocial burden; Quality of life.

Figure 1.

Comparing adjusted predictors of FAIM Expectation of Outcome (EO) and Independent Measure (IM) subdomain scores (unstandardized regression coefficients with 95% confidence intervals). EAI, Epinephrine autoinjector; ED, emergency department; EoE, eosinophilic esophagitis; FA, food allergy; FAIM, Food Allergy Independent Measure; FPIES, Food Protein-Induced Enterocolitis Syndrome.