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Study | Method | Key findings | Recommendations |
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Akeson et al., 2007 [15] | Qualitative study of anaphylactic adolescents and their parents. | Adolescents perceived anaphylaxis as “no big deal” and could not remember a reaction; parents reported anxiety about “handing over” management of anaphylaxis to adolescents. | Tailored information for transition from parental to self-management needed; regular reviews and reinforcement about avoidance and emergency management needed; offer peer support via workshops. |
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Avery et al., 2003 [9] | Peanut allergic and diabetic children compared on a quality of life questionnaire. | Peanut allergic children reported lower quality of life and higher anxiety; epinephrine injectors and eating in familiar places seemed to reduce anxiety. | Anxiety may promote better adherence to allergen avoidance; epinephrine injectors may ease excessive anxiety. |
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Cummings et al., 2010 [10] | Nut allergic children and mothers completed questionnaires on anxiety and quality of life. | Children had lower quality of life relative to norms; mothers and children were less anxious when prescribed epinephrine injectors, regardless of their adherence to precautions. | Prescribe epinephrine injectors to reduce anxiety; provide additional education/advice to improve adherence and reduce risk taking. |
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DunnGalvin et al., 2009 [27] | Comparison of parents of food allergic children who enrolled child in immunotherapy study with those who did not. | Parents who enrolled their children reported higher anxiety, but similar quality of life. | Study samples may be biased towards anxious parents; avoid taking advantage of anxious parents’ vulnerability when recruiting for studies. |
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DunnGalvin et al., 2008 [28] | Evaluation of quality of life questionnaire for parents of food allergic children. | The Food Allergy QoL-Parent Form shows excellent reliability and validity. | Consider using this questionnaire to assess health-related quality of life in parents of food allergic children. |
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Eigenmann et al., 2006 [25] | Survey of food allergic patients after a negative food challenge. | 25% of patients continued to avoid the food, fearing persistence of allergy. | Reassess food consumption in patients with negative food challenge; repeat challenge if avoidance continues. |
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Friedman et al., 1994 [4] | Case series of 10 patients with recurrent unexplained flushing. | Several were originally diagnosed as anaphylactic, but eventually found to have somatization disorders. | Recognition of this presentation is needed to avoid unwarranted examinations and procedures. |
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Hawkes et al., 2010 [29] | Retrospective review of cases admitted to hospital for MMR immunization in Ireland. | Children often admitted due to history of egg allergy, even though risk of anaphylactic reaction is very low in this population. | Advise routine community vaccination for children with egg allergy; educate physicians about their low anaphylaxis risk. |
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Herbert and Dahlquist, 2008 [11] | Comparison of food allergic and nonallergic adolescents/young adults on self-report measures. | Perceived autonomy, anxiety, depression, and parental behavior did not differ between groups; those with anaphylaxis reported more worry and parental overprotection than those with less severe allergies. | Recognize that anaphylactic individuals and their parents are at particular risk for psychological distress; further study is needed. |
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Hu et al., 2008 [16] | Survey and qualitative interviews with parents of food allergic children. | Parents found consumer organizations good sources of practical information and support, but some nonspecific advice and contact with other anxious parents were unhelpful. | Clinicians should guide parents as to what aspects of consumer organizations are most helpful. |
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Khetsuriani et al., 2010 [5] | Review of adverse events in a measles-rubella vaccination campaign in Georgia. | 79 severe adverse events; 37 of these had symptoms of syncope or anxiety attack, and all but one of these was initially diagnosed anaphylactic. | Risk communication strategies for care providers and the public are needed during public vaccination campaigns. |
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King et al., 2009 [14] | Quality of life reports from children with peanut allergy, parents, and siblings. | Mothers reported poorer quality of life and higher anxiety than fathers; separation anxiety greater in children with peanut allergy than their siblings. | Be aware that child’s allergy management may fall to mothers, increasing their personal and family stress; foster allergy self-care for children to reduce anxiety. |
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Lebovidge et al., 2006 [12] | Development and evaluation of a questionnaire regarding parental response to children’s food allergies. | Factor analysis revealed anxiety/distress, psychosocial impact of allergy, parental coping/competence, and family support factors. Greatest anxiety if child had many allergies or had anaphylaxis. | This measure may be a useful screening tool to identify parents of allergic children who are most vulnerable to anxiety and high psychosocial impact of child’s allergy. |
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Lyons and Forde, 2004 [17] | Comparison of adolescents/young adults with/without food allergy on self-report questionnaire. | Allergy had less impact on allergic individuals’ lives than others thought; allergic youth with high health competence reported greatest anxiety; few subjects knew the meaning of the term “anaphylaxis.” | Health education is needed in this population; increased vigilance among health competent individuals may increase anxiety or anxious individuals may self-diagnose food allergy; more research is needed. |
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Mandell et al., 2005 [2] | Qualitative interviews of parents of anaphylactic children. | Repeated cycles of adaptation to episodic anxiety-provoking (i.e., anaphylaxis-related) events challenge families to regain a sense of control. | Recognize patterns of family adaptation to anaphylaxis; help families maintain an optimal balance between protective and debilitating anxiety. |
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Oude et al., 2002 [23] | Randomized controlled trial of patients receiving either immunotherapy or epinephrine injector for yellow jacket allergy. | Quality of life reported as improved in immunotherapy group but not in epinephrine injector group. | Provide venom immunotherapy to improve quality of life and decrease anxiety in this population. |
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Powers, 2004 [6] | Single case report of reaction to jellyfish sting reported as anaphylaxis. | Individual had asthmatic attack due to anxiety induced by the jellyfish sting. | Emergency workers should treat presenting symptoms rather than assuming that anaphylaxis has occurred. |
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Primeau et al., 2000 [18] | Comparison of quality of life and family relations in parents of children with peanut allergy versus rheumatological disease. | Parents of peanut allergic children reported that children had more disruption in daily life and the condition had more impact on the family. | Accurate diagnosis of peanut allergy, support for families, and offering more peanut-free products would help these children and families. |
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Roberts-Thompson et al., 1985 [13] | Retrospective review of 98 cases of bee sting anaphylaxis. | Most reactions occurred in children; considerable anxiety present in some subjects. | Provide venom immunotherapy to alleviate anxiety. |
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Sampson et al., 2006 [19] | Internet questionnaire for 174 food allergic adolescents and young adults. | High-risk behavior associated with less “concern,” and with social situations involving peers. | Education of food allergic teens and also of their peers is needed to reduce risk of anaphylaxis. |
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Sicherer et al., 2001 [20] | Comparison of 253 parents of food allergic children versus established norms on psychosocial function questionnaire. | Low health perception of child, high emotional impact on parent, high limitation of family activities reported, especially if child had multiple food allergies. | Be aware of these psychological effects on child and family; provide family support and education; raise public awareness of the issue; advocate for food labeling. |
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Somers, 2011 [21] | Case report of 11-year old with peanut allergy. | Subject had very restricted diet due to fear of anaphylaxis, affecting weight gain; tense family interactions around meals. | Offer nutritional guidance; use 24-hour food recall; offer behavioral guidelines for parents; get child involved in food preparation to increase confidence. |
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Vargas et al., 2011 [22] | Qualitative study of parents of food allergic children. | Parents wanted (1) concise information on symptoms, cross-contamination of foods, label reading, epinephrine injectors, and advocacy; (2) education of professionals and community. | Parents of newly diagnosed children could benefit from a food allergy management curriculum; clear, concise materials would likely reduce anxiety. |
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Zijlstra et al., 2010 [24] | Parental anxiety measured before and after allergic children underwent food challenges. | Parental state anxiety decreased with food challenge regardless of result; parental trait anxiety was unchanged. | Food challenges may help alleviate parental anxiety about their children’s allergies. |
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