title: The psychological impact of diagnostic food challenges to confirm the resolution of peanut or tree nut allergy.
abstract: BACKGROUND
  Twenty percent of children outgrow peanut allergy and 10% outgrow tree nut allergy. Resolution can be confirmed by a food challenge. Little is known about the psychosocial impact of the challenge. We aimed to investigate effects of a food challenge on anxiety, stress and quality of life (QoL) in children and their mothers on the day of a food challenge to peanuts or nuts, and in the months following the challenge.
  
  
  METHODS
  One hundred and three families participated. Forty children undergoing food challenges to access resolution of allergy, and their mothers, completed validated questionnaires to measure generic and food specific quality of life, stress and anxiety prior to challenge, on the day of investigation and 3-6 months later. Sixty-three children with no clinical indication to challenge (i.e. in the opinion of the allergist had persistent allergy) acted as comparison group completing questionnaires 3-6 months apart.
  
  
  RESULTS
  Mothers reported raised anxiety on the day of challenge (P = 0.007), but children were less anxious. The children (P = 0.01) and mothers (P = 0.01) had improved food-related, but not general, QoL 3-6 months following challenge. Children reported lower anxiety levels following the challenge (P = 0.02), but anxiety remained unchanged in mothers. The improvements in maternal and children's QoL and anxiety levels were irrespective of the challenge outcome and despite co-existing food allergies in 50% of children.
  
  
  CONCLUSIONS
  Mothers experienced increased anxiety on the day of food challenge, unlike the children, perhaps reflecting the differences in their perceived risks. Food challenges are associated with improved food-related QoL in the following months even in those with a positive challenge.
authors.affiliation: Department of Psychology, University of Derby, Derby, UK.
authors.forename: R C
authors.initials: RC
authors.lastname: Knibb
authors.forename: N F
authors.initials: NF
authors.lastname: Ibrahim
authors.forename: G
authors.initials: G
authors.lastname: Stiefel
authors.forename: R
authors.initials: R
authors.lastname: Petley
authors.forename: A J
authors.initials: AJ
authors.lastname: Cummings
authors.forename: R M
authors.initials: RM
authors.lastname: King
authors.forename: D
authors.initials: D
authors.lastname: Keeton
authors.forename: L
authors.initials: L
authors.lastname: Brown
authors.forename: M
authors.initials: M
authors.lastname: Erlewyn-Lajeunesse
authors.forename: G
authors.initials: G
authors.lastname: Roberts
authors.forename: J S A
authors.initials: JS
authors.lastname: Lucas
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D001007:Anxiety / Q000209:etiology; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D007159:Immunologic Tests / Q000523:psychology*; D008297:Male; D009035:Mothers / Q000523:psychology; D021184:Nut Hypersensitivity / Q000175:diagnosis* / Q000523:psychology*; D011795:Surveys and Questionnaires