key: cord-1007636-ib0sg7mh authors: Chen, Gang; DunnGalvin, Audrey; Campbell, Dianne E. title: Impact of COVID‐19 pandemic on quality of life for children and adolescents with food allergy date: 2021-06-28 journal: Clin Exp Allergy DOI: 10.1111/cea.13973 sha: 49abcb03aaf59e7248367243a6263718478eaef9 doc_id: 1007636 cord_uid: ib0sg7mh The 2019 novel coronavirus disease (COVID-19) outbreak has substantially impacted the daily lives of people. The isolation and quarantine measures may also have negatively impacted wellbeing in individuals with food allergy (FA), who may be more vulnerable in some areas than the general public. For example, food shortages and lockdown policies have required changes in food purchasing habits, potentially limiting food choices;1 furthermore, it is likely that COVID-19 prevented access to FA-related medical care. The 2019 novel coronavirus disease (COVID-19) outbreak has substantially impacted the daily lives of people. The isolation and quarantine measures may also have negatively impacted well-being in individuals with food allergy (FA), who may be more vulnerable in some areas than the general public. For example, food shortages and lock-down policies have required changes in food purchasing habits, potentially limiting food choices 1 ; furthermore, it is likely that COVID-19 prevented access to FA-related medical care. Respondents were asked to assess the impact of COVID-19 based on the question: "To which extent have any of the following circumstances in your child's life been affected by the current coronavirus (COVID-19) pandemic over the last few months (since January 2020)," and were offered five options: much worse, somewhat worse, about the same (no influence), somewhat better and much better. For statistical analyses, the perceived negative and positive impacts were combined, that is those who answered "much worse" and "somewhat worse" were combined, as well as "somewhat better" and "much better." Respondents were asked to state to what extent they agreed or disagreed with a series of statements concerning food experiences related to the pandemic. Survey profile questions gathered data on FA history, and children's and proxy respondents' socio-demographic characteristics. Descriptive statistics were calculated for demographic and clinical data. The subjective well-being outcomes were plotted according to whether respondents reported negative impacts or not due to the COVID-19 pandemic. Given the non-normally distributed outcome variables, the nonparametric Mann-Whitney U test was used to compare the well-being outcomes between subgroups according to whether a negative influence from COVID-19 was reported. Two-sided p-values were reported for all statistical tests, and a p-value below .05 was considered to be statistically significant. Statistical analyses were performed using Stata version 16.1 software (StataCorp LP). A total of 247 respondents participated in the COVID-19 survey. The children with FA had a mean (standard deviation) age of 7.8 (4.6) years (range 1-17 years), 37% were girls and 98% of whom had an allergy specialist confirmed diagnosis of FA. Overall, 13% of parentproxy respondents reported that COVID-19 pandemic and selfisolation/quarantine measures had prevented their children from receiving medical care related to FA "quite a lot," "very much" or "ex- • We surveyed parents of children and adolescents with food allergy before and during the pandemic. • Parent/carer report of a negative impact was associated with worse quality of life and life satisfaction. • Difficulties accessing "safe" foods and food allergyrelated health services were commonly reported. Additionally, 27% of children and adolescents who sought medical care reported difficulty accessing FA-related health services due to COVID-19. The pandemic was also reported as negatively influenced food experiences, with 26% (50/192) of proxy respondents reporting anxiety about giving their child new foods and 5% reporting an accidental exposure resulting in an allergic reaction, which was attributed to the introduction of new foods due to "staple/safe" food shortages. There are several limitations of this study. First, it was a voluntary, online survey designed to facilitate participation. It is likely that respondents, especially those who participated in the proxyreported survey, represent families with a higher-than-average socio-economic band and higher educational attainment level. Secondly, there could be discrepancy around self-reported versus proxy-reported HRQL/FAQL scores for children and adolescents, yet most disagreements tended to be minor. 9 The decision to focus on the proxy-report approach was to ensure that assessment and comparison could be made for children across a wider age range. This approach also allowed for recruitment via parents online, which would not have been an appropriate way to recruit children directly during the pandemic. Finally, although the cross-sectional nature of the survey prevents drawing a direct causal relationship between any COVID-19 impacts and well-being, the comparison with Pre-COVID-19 survey data, which were collected on a very similar population via the same A&AA network, suggests a possible causal relationship does exist. This is the first study to reveal a comprehensive picture of how COVID-19 impacted the subjective well-being of children and adolescents with FA using a series of validated well-being measures. Difficulties accessing "safe" foods and FA-related health services were commonly reported. Those children and adolescents whose parent/carers proxy-reported negative impact from the COVID-19 pandemic had significantly poorer subjective well-being overall. Our findings suggest that this subgroup require specific identification F I G U R E 2 Distribution of life domain satisfaction of children and adolescents with food allergy by proxy-assessed COVID-19 impacts on each life domain Healthy food retail during the COVID-19 pandemic: challenges and future directions Quality of life in childhood, adolescence and adult food allergy: patient and parent perspectives High anxiety and health-related quality of life in families with children with food allergy during coronavirus disease 2019 Predicting time trade-off health state valuations of adolescents in four Pacific countries using the Assessment of Quality-of-Life (AQoL-6D) instrument Valuing the Child Health Utility 9D: using profile case best worst scaling methods to develop a new adolescent specific scoring algorithm A short simple tool to measure the impact of food allergy on patients in routine clinical practice; the Food Allergy Quality of Life Questionnaire, Parent Form 10 (FAQLQ-PF10) Validation of food allergy quality of life short forms (FAQLQ-10) for parents, children and teens Analysing the comparability of 3 multi-item subjective well-being psychometric scales among 15 countries using samples of 10 and 12-year-olds On your own feet research G. The proxy problem anatomized: child-parent disagreement in health related quality of life reports of chronically ill adolescents