Parental Illness Perceptions Drive Poor QoL in Children with Food Allergies

In children with food allergies, poorer quality of life is linked to internalizing mental health problems, parental illness perceptions, multiple allergens, and a history of anaphylaxis.1

“The study highlights how parental perceptions are intertwined with the child’s emotions and behaviors, and in some cases, are associated with an impaired QoL,” wrote study investigator Laura Polloni, PsyD, from the Food Allergy Referral Center at Padua University Hospital in Italy, and colleagues.

Food allergy affects approximately 8% of children in the US, increasing to 11% when parent-reported cases not confirmed by specialists are included.2,3 Prior research has demonstrated substantial discrepancies between medically diagnosed food allergy and caregiver reports.4,5 Parental beliefs about a disease and its treatment can, in turn, shape how children manage their illness, influencing attitudes, emotions, behaviors, treatment adherence, health outcomes, and overall quality of life.1

In this cross-sectional study, investigators examined the relationship between parental illness perception, mental health, and quality of life among children with food allergies. The sample included 79 parents (mean age, 42.94 years; 53% mothers) of children aged 3 – 12 years (mean age, 7.97 years; 56% male), recruited during outpatient visits at the Food Allergy Referral Centre of the Veneto Region in Padua (North-Eastern Italy) over 6 months. Most children had multiple food allergies (84%) and a history of anaphylaxis (86%).1

Participants completed the Food Allergy Quality of Life Questionnaire—Parent Form (FAQLQ-PF), Strengths and Difficulties Questionnaire (SDQ), and Brief Illness Perception Questionnaire (B-IPQ). The SDQ assessed emotional and behavioral domains (hyperactivity and inattention, peer problems, and prosocial behavior), with higher scores indicating greater difficulties (except prosocial behavior).1

B-IPQ evaluated cognitive and emotional illness representations across 9 dimensions: timeline (perceived duration of illness), identity (symptoms a person associates with the illness), personal control (the belief that the individual can control their illness), treatment control (the belief that the illness can be managed or cured through treatment), concern (worry of the illness), emotions (the emotional impact of the illness), coherence (the degree to which a person understands their illness), cause (personal ideas about the origins of the illness). A higher score indicated stronger illness perception.1

FAQ-PF scores ranged from 2.98 to 3.18 (0 - 6 scale). The mean SDQ total score for emotional-behavioral difficulties was 10.99, within normal limits, with similar internalizing and externalizing profiles. Parents perceived timeline, identity, concern, emotions, and consequences for the child and parent as the dimensions of illness (B-IPQ) that had the greatest impact, while treatment control, coherence, and personal control had the least. Nearly half attributed (49%) the disease to genetics and not the environment, stress or chance, though no correlation with disease cause was observed (P >.05).1

Children’s quality of life was positively associated with behavioral difficulties (FAQLQ, 0.28), particularly internalizing problems (0.33). Quality of life was also positively associated with illness perceptions (B-IPQ, 0.64), including consequences for the child and parents (0.66), expected timeline (0.43), and emotional representation (0.63). Behavioral difficulties were negatively associated with parental control (SDQ, −0.27) and illness understanding (−0.24). Internalizing problems were negatively associated with parental control (−0.23) and positively associated with expected timeline (0.24).1

A greater number of allergens was linked to worse quality of life (P <.05), and prior anaphylaxis was associated with higher illness identity (P <.05). Children aged 7 to 12 years reported lower personal and treatment control (P =.002 and P =.017, respectively) and coherence (P =.006). The final model showed that internalizing problems, longer perceived timeline, and stronger emotional representation predicted poorer quality of life (P <.001).1

Additionally, multiple food allergies were moderately associated with a child’s worse quality of life (P =.024). Prior anaphylaxis (P =.010) and male sex (P =.012) were associated with greater illness perception.1

Male parenthood was associated with a lower perceived parental consequences (P =.023), emotional representation (P =.001), and identity (P =.010), but weakly associated with concern (P =.040) and lower B-IPQ scores (P =.04).1

“The findings underscore the importance of understanding and exploring the illness perception of caregivers of pediatric patients with FA, as well as paying particular attention to the psychosocial–emotional aspects of the illness in both children and parents,” investigators wrote.1 “Clinicians should investigate caregivers’ illness perceptions and offer evidence-based information, discussion of doubts and concerns, training in FA and anaphylaxis management, and, when appropriate, referral for psychological support.”

References

1. Polloni L, Ronconi L, Bonichini S, et al. Quality of Life, Mental Health, and Illness Perception in Pediatric Food Allergy. Children (Basel). 2025;12(12):1657. Published 2025 Dec 6. doi:10.3390/children12121657

2. Gupta RS, Warren CM, Smith BM, et al. The Public Health Impact of Parent-Reported Childhood Food Allergies in the United States. Pediatrics. 2018;142(6):e20181235. doi:10.1542/peds.2018-1235

3. Warren CM, Jiang J, Gupta RS. Epidemiology and Burden of Food Allergy. Curr Allergy Asthma Rep. 2020;20(2):6. Published 2020 Feb 14. doi:10.1007/s11882-020-0898-7

4. Teufel M, Biedermann T, Rapps N, et al. Psychological burden of food allergy. World J Gastroenterol. 2007;13(25):3456-3465. doi:10.3748/wjg.v13.i25.3456

5. Gupta RS, Springston EE, Smith B, Pongracic J, Holl JL, Warrier MR. Parent report of physician diagnosis in pediatric food allergy. J Allergy Clin Immunol. 2013;131(1):150-156. doi:10.1016/j.jaci.2012.07.016