A recent systematic review has been published Clinical and experimental allergyResearchers examined the correlation between immunoglobulin E (IgE)-related food allergy and health-related quality of life (HRQL) and biological sex in their caregivers.
Food allergy has a significant impact on individuals and their caregivers, resulting in poor health-related quality of life (HRQL) due to severe dietary restrictions, lack of treatment options, and fear of inadvertent exposure. Previous studies have reported on the psychological well-being and lifestyle effects of food allergy patients and their families but have considered a subset of the patient population, particularly gender.
Understanding the characteristics that influence HRQL is important for appropriate food allergy care, yet there is inconsistency regarding the role of biological sex on HRQL outcomes in individuals with food allergy. Caregivers, especially mothers, often bear the burden of managing food allergy-related concerns, and mothers are overrepresented in the food allergy literature, possibly due to gender differences in parenting.
About systematic reviews
In the current systematic review, researchers examined gender-specific health-related quality of life (HRQL) measures in food allergy patients, comparing them with their parents and participants. They also investigated the effect of gender on allergen resistance and treatment.
The team searched the Embase and Medline databases on April 4, 2022, updating them on December 5, 2023, with records from the APA PsycINFO database. Included studies were interventional or non-interventional studies published in English, reporting original research on the relationship between biological sex and health-related quality of life assessed using validated instruments in individuals with immunoglobulin E-mediated food allergy.
The group excluded studies assessing HRQL in individuals with non-IgE-related food allergy and multiple allergies. They also excluded descriptive reviews, case studies, gray literature, conference abstracts, opinion pieces, and systematic reviews. Study interventions included educational, medical, and psychological types. For sex-stratified subgroups of unadjusted health-related quality of life scores, the team extracted p-values indicating differences in HRQL versus women. male
Two researchers independently screened titles and abstracts prior to full-text review to ensure eligibility. The team used the ROBINS-E tool to conduct risk of bias in non-randomized studies of interventions (ROBINS-I) and sensitivity analyzes for non-intervention records to assess study quality. They assessed risk of bias using traffic light plots.
Initially, the team identified 4,799 studies, of which 3,927 performed title-abstract screening, 426 performed full-text screening, and 34 studies (24 non-interventional and 10 interventional) were analyzed. The researchers used several HRQL instruments in the included studies, of which the age-specific Food Allergy Quality of Life Questionnaire (FAQLQ) was the most frequent, revealing sex-based differences in subdomains associated with emotional impact and dietary risk.
Female participants with food allergy (63% of studies with pediatric participants, 83% of studies with adult participants) and maternal parents of individuals with food allergy (50% of caregiver studies) reported poorer health-related quality of life than their male counterparts, regardless of age, especially In mental, physical, and food anxiety-related well-being domains. The team observed sex-based disparities in children’s health-related quality of life after food allergen immunological therapy. However, selective documentation in intervention studies indicated that the directional course of the association was clear.
Caregiver gender did not affect study participants’ proxy-recorded health-related quality of life, nor did child biological gender affect caregiver health-related quality of life. All but one study found Robbins-eye critical for serious risk of bias ratings. The most frequent sources of bias in the included studies were related to HRQL measurements because investigators and study participants were aware of the intervention and exposure status and through inconsistent or insufficient consideration of confounding factors. Sensitivity analysis found little difference in risk of bias classification of poor quality across four studies of non-interventional type assessed using the Robbins-E tool to account for insufficient consideration of primary sources of bias.
Overall, the review findings highlighted the effect of gender on HRQL in IgE-related food allergy, with female adults and children reporting lower baseline overall HRQL and mothers experiencing lower subdomain HRQL. Findings emphasize the need for personalized allergy treatment strategies and stratifying HRQL outcomes by gender in allergen immunotherapy studies.
In food allergy investigations, biological sex should be considered as a factor influencing overall and domain-specific HRQL outcomes. Women with food allergy had lower baseline HRQL total scores than men, with comparable gender differences across HRQL subdomains.
The study revealed that an interaction between gender and type of allergen may influence HRQL outcomes after therapy. Future studies should focus on gender in HRQL to reduce reliance on subgroup and sensitivity analyses.