Children with Severe Peanut Allergy Have Comparable Quality of Life to Peers

A recent study showed children with suspected severe peanut or tree nut allergies had a similar health-related quality of life to children in the general population.1

“This implies that these children are generally otherwise healthy and/or their health conditions are managed properly,” wrote investigators, led by Lasse Saarimäki, from Tampere University Hospital in Finland.

Peanut and tree nut allergies, commonly occurring in children, are less likely to resolve than food allergies of milk, soy, and wheat. Worse, the incidence of peanut allergies and severe allergic reactions has been rising in children despite efforts to manage nut allergies by introducing peanuts at an early age.

Research has shown the health-related quality of life is lower among children with a peanut or tree nut allergy and their caregivers.2 Yet, the nut allergy’s impact on quality of life varies with age, adrenaline usage, and nut type, with significant differences between countries.1

Many parents also experience fear regarding their child’s nut allergy, even when their child has yet to experience anaphylaxis. Just holding around an adrenaline autoinjector in case their child goes into anaphylaxis can impact the parent’s health-related quality of life.

Investigators sought to assess the health-related quality of life among 101 children aged 3 – 15 years (mean age: 7.7 years) at risk of a severe peanut or tree allergy, along with their parents. The study was a part of Tampere ALL NUTS, a Finnish ongoing single-center cohort of children referred to a pediatric allergist consultant at Tampere University Hospital between 2021 and 2024 due to suspicion of a severe peanut or tree nut allergy. The suspicion was based on previous severe symptoms or positive molecular immunology test results.

Children were included in the study if they had either a history of anaphylaxis or another severe allergic reaction caused by peanuts or tree nuts, such as cashews, walnuts, hazelnuts, pistachios, and pecans.

Children were also included if they had a positive molecular immunology test (immunoglobulin E levels > 0.35 kU/L), indicating a severe reaction. The immunology test examined for the following risk components: ra h2, Ara h6, Cor a14, Cor a9, Cor a8, Ana o3, Jug r1 and Jug r3. Children could not have undiagnosed or uncontrolled asthma.

Health-related quality of life was assessed using the questionnaires 15D (for adults ≥ 16 years), 16D (ages 12 – 15 years), and 17D (ages < 12 years). The 17D questionnaire was completed by either the parents or the child, depending on the child’s literacy skills.

The study also included a reference group who completed these questionnaires, with 244 children < 12 years old, 373 teenagers between 12 and 15 years old, and 1151 adults aged 25 – 45 years. This reference group represented the general child population in Finland.

Health-related quality of life scores were similar for teenagers with a severe peanut or tree nut allergy (0.955 vs 0.947; P = .54) and their parents compared to reference populations. However, the distress of parents with a teenager severely allergic to peanut or tree nuts was statistically worse than the reference group (score difference, 0.042; 0.890 vs 0.932; P = .013).

Moreover, children aged 3 – 11 years had significantly greater scores in health-related quality of life than the reference group (0.959 vs 0.938; P < .01).

Thus, children with suspected severe allergies and those without showed no difference in HRQoL. Investigators explained this may be because younger children with peanut allergies face less HRQoL impairment, as older children are more at risk. Since symptoms occur only upon exposure, the impact on HRQoL comes from fear of contact, which younger children may not fully grasp.

However, parents of children with suspected severe peanut or tree nut allergies had significantly worse health-related quality of life than the reference group (0.884 vs 0.932; P = .008).

“It is concerning that parental distress of these children seems to be increased, especially when it is observed with a generic HRQoL instrument,” investigators wrote. “More focus should be emphasized to parents when treating children with nut allergies. Parents should be told that no children have died from anaphylaxis in Finland in past years and that severe allergic reactions very seldom cause any sequelae after correct treatment.”

References

1. Saarimäki L, Kivistö JE, Ojaniemi I, Sintonen H, Huhtala H, Protudjer JLP, Ekström S, Kull I, Karjalainen J. Generic Health-Related Quality of Life of Children With Severe Peanut or Tree Nut Allergy. Acta Paediatr. 2025 Feb 6. doi: 10.1111/apa.70016. Epub ahead of print. PMID: 39912585.

2. Pasioti M, Savva M, Lakoumentas J, Kompoti E, Makris M, Xepapadaki P, Papadopoulos NG. Impact of Presumed Tree Nut and Peanut Allergy on Quality of Life at Different Ages. J Clin Med. 2023 May 15;12(10):3472. doi: 10.3390/jcm12103472. PMID: 37240577; PMCID: PMC10218855.