title: Differences in Caregiver Food Allergy Quality of Life Between Tertiary Care, Specialty Clinic, and Caregiver-Reported Food Allergic Populations.
abstract: BACKGROUND
  Food allergy is associated with diminished caregiver quality of life (QoL), but the heterogeneity of this effect is unknown.
  
  
  OBJECTIVE
  The objective of this study was to explore potential differences in caregiver QoL between self-selected caregivers reporting a child with food allergy (SS) and caregivers with children followed at a food allergy referral center clinic (RC).
  
  
  METHODS
  The Food Allergy Quality of Life Parental Burden (FAQL-PB) index and screening questions regarding the child's most severe food reaction were administered to caregivers of milk, egg, peanut, or tree nut allergic children. SS were recruited via the email and/or social media networks of 2 large national food allergy advocacy groups, and RC from a tertiary referral center specialty clinic.
  
  
  RESULTS
  Among 2003 SS and 305 RC, the mean total FAQL-PB QoL score was 2.67. Compared with SS, RC had a lower (better) mean total QoL score (1.84 vs 2.81, P < .001), individual FAQL-PB domain scores (mean difference range 0.51-1.93; all P < .001), and lower QoL scores for all allergens (mean difference range 0.89-1.32; peanut P < .001, tree nut P < .001, milk P = .006, egg P = .001). In an adjusted multiple linear regression model, RC were associated with a lower QoL score (-1.6 [95% CI, -1.91 to -1.29], P < .001). Factor analysis of the index revealed 2 dimensions. A minimal clinically important difference of 0.3 was calculated for the FAQL-PB using the standard error of measurement method.
  
  
  CONCLUSIONS
  Caregiver food allergy QoL is heterogeneous, and worse among SS versus RC. Clinically and statistically significant differences were noted in the total, domain-specific, and allergen-specific QoL scores, which indicated that the food allergic population may be segmented and have different risk profiles and/or burdens of illness, despite a common diagnosis.
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Mich.
authors.forename: Claire
authors.initials: C
authors.lastname: Ward
authors.affiliation: Division of Allergy and Clinical Immunology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Mich; Department of Pediatrics, Child Health Evaluation and Research Unit, University of Michigan Medical School, Ann Arbor, Mich. Electronic address: mgreenha@med.umich.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Greenhawt
mesh_terms: D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005512:Food Hypersensitivity / Q000453:epidemiology*; D006782:Hospitals, Special; D006801:Humans; D008297:Male; D018802:Patient-Centered Care; D044382:Population Groups; D011446:Prospective Studies; D011788:Quality of Life; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D063128:Tertiary Health Care
keywords: Anaphylaxis; Epinephrine; Food Allergy Quality of Life-Parental Burden; Food allergy; Prevalence; Quality of life; Self-efficacy; Self-reported food allergy