OBJECTIVES: Food allergy adversely affects the health-related quality of life (HRQoL) of children with peanut allergy. However, it is unclear whether specific factors such as the reaction eliciting dose of allergen consumed and the nature of allergic reaction symptoms affect HRQoL.

METHODS: This study was an analysis of baseline data from the PPOIT-003 randomized trial of 212 children aged 1-10 years with challenge-confirmed peanut allergy. Past reaction symptoms and eliciting dose during supervised food challenge were recorded by clinicians during trial screening. Associations between the variables of interest and caregiver proxy-reported child HRQoL, measured by Food Allergy Quality of Life Questionnaire, were examined by linear regression.

RESULTS: Participants had a mean age of 5.9 years and 63.2% were male. Children with a low reaction eliciting dose (80mg peanut protein) had significantly poorer (higher) HRQoL scores (β:0.81 [95% CI: 0.00 to 1.61], p=0.049) compared to children with a high eliciting dose (2500mg peanut protein). Gastrointestinal symptoms (β:0.45 [0.03 to 0.87], p=0.037), lower airway symptoms (β:0.46 [0.05 to 0.87], p=0.030), multi-system involvement (β:0.71 [0.25 to 1.16], p=0.003), or anaphylaxis (β:0.46 [0.04 to 0.87], p=0.031) during a previous reaction were also associated with worse HRQoL.

CONCLUSIONS: Children with a low allergen reaction eliciting dose threshold or significant past reaction symptoms, particularly affecting the gastrointestinal or lower respiratory systems, reported worse HRQoL. Children experiencing these symptoms and those with lower reaction eliciting dose may require increased clinical support to manage their food allergy and are likely to benefit from interventions that can improve HRQoL.