Developmental Aspects of Health Related Quality of Life (HRQL) in Food Related Chronic Disease: The Example of Food Allergy



Health related quality of life (HRQL) measures provide a powerful means of measuring outcomes, enabling service providers in the clinical field to audit ‘outcome’ information for particular populations, thereby altering and improving resources and programmes, and prioritizing needs. However, there are important questions that must be answered before HRQL measures can reach their full potential in research, practice and policy. One of the most important concerns the impact of developmental processes on HRQL perception, impact and health outcomes. In this chapter, using food allergy as an example, we review research on health related quality of life in children, teens and parents. We draw on neurobiological literature in allergic diseases, in addition to some of the key psychobiological theories in the current work on threat perception in health to argue for a broader understanding of HRQL. This review also aims to provide a scientific basis for the development of appropriate models linking symptoms, functioning, development, underlying physiological mechanisms and HRQOL. An integrated developmental perspective may also illuminate our understanding of individual differences in the expression and impact of chronic diseases involving diet and food. The implications of this developing field of research are enormous with implications for the interpretation and usefulness of HRQL measures and its application to clinical practice, health policy, cause and effect pathways, the development of psycho-educational interventions and the precise targeting of information.


Food Allergy Food Challenge Peanut Allergy Food Allergic Child Enable Service Provider 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Health Related Quality of Life


Food Allergy Quality of Life Questionnaire


Parent Form


Food Allergy Independent Measure


Oral Immunotherapy



This work was funded by the EU through the EuroPrevall project (FOOD-CT-2005-514000).


  1. Austin JK, Dunn DW, Huster GA. Childhood epilepsy and asthma: changes in behavior problems related to gender and change in condition severity. Epilepsia. 2000;41:615–23.PubMedCrossRefGoogle Scholar
  2. Avery NJ, King RM, Knight S, Hourihane JOB. Assessment of quality of life in children with peanut allergy. Pediatr Allergy Immunol. 2003;14:378–82.PubMedCrossRefGoogle Scholar
  3. Black PH. Brain Behav Immun. 2002;16:622–53.PubMedCrossRefGoogle Scholar
  4. Brosschot JF. Cognitive–emotional sensitization and somatic health complaints. Scand J Psychol. 2002;43 (2):113–21.PubMedCrossRefGoogle Scholar
  5. Bollinger ME, Dahlquist LM, Mudd K, Sonntag C, Dillinger L, McKenna K. The impact of food allergy on the daily activities of children and their families. Ann Allergy Asthma Immunol. 2006;96:415–21PubMedCrossRefGoogle Scholar
  6. Charmaz K. Grounded theory: objectivist and constructivist methods. In Denzin N, Lincoln Y, editors. Handbook of qualitative research. 2nd edn. Thousand Oaks: Sage; 2000. p. 509–535.Google Scholar
  7. Cohen BL, Noone NS, Munoz-Furlong A, et al. Parental burden in food allergy. Journal of Allergy Clin Immunol. 2004;114 5:1159–63.CrossRefGoogle Scholar
  8. DiChiara G, Bassareo V, Fenu S, DeLuca MA, Spina L, Cadoni C, Acquas E, Carboni E, Valentini V, Lecca D. Dopamine and drug addiction: the nucleus accumbens shellconnection. Neuropharmacology. 2004;47:227–41.CrossRefGoogle Scholar
  9. DunnGalvin A, Hourihane J O’B, Frewer L, Knibb RC, Oude Elberink JNG, Klinge, I. Incorporating a gender dimension in food allergy research: a review. Allergy. 2006;61:1336–43.PubMedCrossRefGoogle Scholar
  10. DunnGalvin A, de Blok BMJ. Dubois A, Hourihane JO’B. Development and Validation of the Food Allergy Quality of Life – Parent Administered Questionnaire (FAQLQ-PF) for food allergic children aged 0-12 years. Clinical and Experimental Allergy. 2008;38:977–86.CrossRefGoogle Scholar
  11. DunnGalvin A, Dubois AEJ, Hourihane J. Child vs maternal perception of HRQoL in food allergy: developmental trajectories and evolution of risk behaviour. Allergy. 2007;62 (Suppl. 83):70–166.Google Scholar
  12. DunnGalvin A, Roberts S, Hourihane JO’B. Causal pathway analysis of mothers’ responses to government advice on peanut avoidance. Oxford Journal of Public Health. 2008a;30(1):114–5.Google Scholar
  13. DunnGalvin A, Gaffney A, Hourihane JO’B. Developmental pathways in food allergy: a new theoretical model. Allergy. 2009a;64:560–8.PubMedCrossRefGoogle Scholar
  14. DunnGalvin A, Hourihane JO’B. Self-assessment of reaction thresholds in food allergy: a new theory of risk taking which changes over time. J Allergy Clin Immunol. 2009b;123:S142.CrossRefGoogle Scholar
  15. DunnGalvin A, Hourihane JO’B. Developmental trajectories in allergic diseases: A review. Advances in Food and Nutrition Research, Elsevier Inc. 2009c. Volume 56 (pp. 65–102).Google Scholar
  16. DunnGalvin A, Burks WJ, Dubois AEJ, Chang WC, Hourihane JO’B. Profiling Families Enrolled in Food Allergy Immunotherapy Studies DunnGalvin A, Chang WC, Laubach S, Steele PH, Dubois AEJ, Wesley Burks AW, Hourihane JO’B, Pediatrics 2009d;124:e503–e509.Google Scholar
  17. DunnGalvin A, Cullinane C, Daly D, Flokstra-de Blok BMJDubois AEJ, Hourihane JO’B..Longitudinal validity and responsiveness of the Food Allergy Quality of Life Questionnaire – Parent Form (FAQLQ-PF) in children 0-12 years following positive and negative food challenges. Clin Exp Allergy. 2010;40(3):476–85Google Scholar
  18. DunnGalvin A, Hourihane JO’B. (submitted) A Chronic Disease Impacts Directly on Child’s Normal Trajectory of Psychological Development in Both a Generic and Disease-Specific Manner: Similarities and Differences in Food Allergy and Diabetes.Google Scholar
  19. Elenkov IJ, Wilder RL, Chrousos GP, Vizi ES. The sympathetic nerve – an integrative interface between two ­supersystems: The brain and the immune system. Pharmacol Rev. 2000;52:595–638.Google Scholar
  20. Engle G. The need for a new medical model: a challenge for biomedicine. Science 1977;197:129–96.CrossRefGoogle Scholar
  21. Feeney JA. Implications of attachment style for patterns of health and illness. Child Care Health Dev. 2000;26: 277–88.PubMedCrossRefGoogle Scholar
  22. Ferrans CE, Zerwic JJ, Wilbur JE, Larson JL. Conceptual model of health related quality of life. J Nursing Scholarship. 2005;27:336–42.CrossRefGoogle Scholar
  23. Flokstra-de Blok BMJ, DunnGalvin A, Vlieg-Boersta BJ, Oude Elberink JNG, Duiverman EJ, Hourihane JO, Dubois AEJ. Development and validation of a self-administered Food Allergy Quality of Life Questionnaire for children. Clin Exp Allergy. 2009;39:127–37.PubMedCrossRefGoogle Scholar
  24. Flokstra-de Blok BMJ, DunnGalvin A, Vlieg-Boerstra BJ, Oude Elberink JNG, Duiverman EJ, Hourihane JO, Dubois AEJ. Development and validation of the self-administered Food Allergy Quality of Life Questionnaire for adolescents. J Allergy Clin Immunol. 2008;122:139–44.PubMedCrossRefGoogle Scholar
  25. Flokstra-de Blok BMJ, van der Meulen GN, DunnGalvin A, Vlieg-Boerstra BJ, Oude Elberink JNG, Duiverman EJ, Hourihane JO, Dubois AEJ. Development and validation of the first disease-specific quality of life questionnaire for adults; The Food Allergy Quality of Life Questionnaire-Adult Form (FAQLQ-AF). Allergy 2009;64(8):1209–17.Google Scholar
  26. Gutteling BM, de Weerth C, Buitelaar JK Maternal prenatal stress and 4–6 year old children’s salivary cortisol concentrations pre- and post-vaccination. Stress. 2004;7:257–60.PubMedCrossRefGoogle Scholar
  27. Gutteling BM, de Weerth C, Buitelaar JK. Prenatal stress and children’s cortisol reaction to the first day of school. Psychoneuroendocrinology. 2005;30:541–9.PubMedCrossRefGoogle Scholar
  28. Gunnar M, Sebanc A, Tout K, Donzella MA, van Dulman M. Temperament, peer relationships, and cortisol activity in preschoolers. Dev Psychbiol. 2003;43:346–68.CrossRefGoogle Scholar
  29. Halfon N, Hochstein M. Life course health development: An integrated framework for developing health, policy and research. In: Milbank Q.80:433–79; 2002.Google Scholar
  30. Hoey, H, Mortensen, H, McGee, H, & Fitzgerald, M, for the Hvidore Study Group. Is metabolic control related to quality of life? A study of 2103 children and adolescents with IDDM from 17 countries. Diab Res Clin Pract. 1999;44 (Suppl):S3.Google Scholar
  31. Hourihane JO, Roberts SA, Warner JO. Resolution of peanut allergy: case-control study BMJ. 25 Apr 1998a;316 (7140):1271–5.Google Scholar
  32. Hourihane JO. Prevalence and severity of food allergy – need for control. Allergy. 1998b;53 (46 Suppl):84–8.PubMedCrossRefGoogle Scholar
  33. Hourihane JOB, Flokstra-de Blok BMJ, Dubois AEJ, Kahlon R, Dunn Galvin A. Food challenge has a rapidly established and persistent positive effect on quality of life of children 0–12 years irrespective of the clinical outcome of the challenge. J Allergy Clin Immunol. 2009;123:S143.CrossRefGoogle Scholar
  34. Johansson SGO, Bieber T, Dahl R. Revised nomenclature for allergy for global use: report of the Nomenclature Review Committee of the World Allergy Organisation. J Allergy Clin Immunol. 2004;5:832–6.CrossRefGoogle Scholar
  35. Katon W. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness. Biol Psychiatry. 2004;54:216–26.CrossRefGoogle Scholar
  36. Kang DH, Coe CL, McCarthy DO, Ershler WB. Immune responses to final exams in healthy and asthmatic adolescents. Nurs Res. 1997;46:12–9.PubMedCrossRefGoogle Scholar
  37. Kovalenko PA, Hoven CW, Wu P, Wicks J, Mandell DJ, Tiet Q. Association between allergy and anxiety disorders in youth. Aust New Zealand J Psychiatry. 2001;35: 815–21.CrossRefGoogle Scholar
  38. Kyngas H, Hentinen M. Meaning attached to compliance with self-care, and conditions for compliance among young diabetics. J Adv Nursing. 1995;21:729–36.CrossRefGoogle Scholar
  39. LeDoux JE, Phelps EA. Emotional networks in the brain. In Lewis, M, Haviland J, editors. Handbook of emotions. New York: Guilford Press; 2000. pp. 134–145.Google Scholar
  40. Maier SF, Watkins LR. Stressor controllability, anxiety, and serotonin. Cognit Ther Res 1998;22:595–613.CrossRefGoogle Scholar
  41. Marklund B, Ahlstead, Nordstrom G. Health-related quality of life among adolescents with allergy-like conditions – with emphasis on food hypersensitivity. Health and Quality of Life Outcomes 2004;2:65–9.PubMedCrossRefGoogle Scholar
  42. McAfoose J, Baune BT. Evidence for a cytokine model of cognitive function. Neurosci Biobehav Rev. 2009;33:355–66.PubMedCrossRefGoogle Scholar
  43. McCaugh JL. The amygdala modulates the consolidation of memories of emotionally arousing experiences. Annu Rev Neurosci. 2004;27:1–28.CrossRefGoogle Scholar
  44. Mullins LL, Wolfe-Christensen C, Hoff Pai AL, Carpentier MY, Gillaspy S, Cheek J, Page M. The relationship of parental overprotection, perceived child vulnerability, and parenting stress to uncertainty in youth with chronic illness. J Paediatric Psychol 2007;32:973–82CrossRefGoogle Scholar
  45. Morris AD, Boyle DI, McMahon AD, Greene SA, MacDonald TM, Newton RW. Adherence to insulin treatment, glycaemic control and ketoacidosis in insulin-dependent diabetes mellitus. The DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside Scotland. Medicines Monitoring Unit. Lancet. 1997;350:1505–10.PubMedCrossRefGoogle Scholar
  46. O’Connor TG, Heron J, Golding J, Glover V, the ALSPAC study team. maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. J Child Psychol Psychiat 2003;44:1025–36.PubMedCrossRefGoogle Scholar
  47. Overmier JB. Sensitization, conditioning, and learning: can they help us understand somatization and disability? Scand J Psychol. 2002;43 (2):105–12.PubMedCrossRefGoogle Scholar
  48. Primeau MN, Kagan R, Joseph L, Lim H, Dufresne C, Duffy C, Prhcal D, Clarke A. The psychological burden of peanut allergy as perceived by adults with peanut allergy and the parents of peanut-allergic children. Clin Exp Allergy. 2000;30:113.CrossRefGoogle Scholar
  49. Rosenkranz MA, Busse WW, Johnstone T, Swenson CA, Crisalfi GM, Jackson MM et al. Neural circuitry underlying the interaction between emotion and asthma symptom exacerbation. Proc Natl Acad Sci. 2005;102:13319–24.PubMedCrossRefGoogle Scholar
  50. Sampson HA. Food allergies. In M Feldman et al., editors. Sleisenger and Fordtran’s gastrointestinal and liver disease. 8th ed., vol. 1. Philadelphia: Saunders; 2005. pp. 427–439.Google Scholar
  51. Schmidt S. Coping with chronic disease from the perspective of children and adolescents – a conceptual framework and its implications for participation. Child Care Health Dev. 2003;29 1: 63–75.PubMedCrossRefGoogle Scholar
  52. Sicherer SH. Food allergy. Lancet. 2002;360:701–10.CrossRefGoogle Scholar
  53. Timonen M, Jokelainen J, Hakko H, Silvennoinen-Kassinen S, Meyer-Rochow VB, Herva A Räsänen P.Atopy and depression: results from the Northern Finland 1966 Birth Cohort Study.Mol Psychiatry. 2003;8(8):738–44.Google Scholar
  54. Ursin H, Eriksen HR. Sensitization, subjective health complaints, and sustained arousal. In: Sorg B, Bell I, editors. The role of neural plasticity in chemical intolerance. Ann N Y Acad Science 933:119–29; 2001.Google Scholar
  55. von Hertzen LC. Maternal stress and T-cell differentiation of the developing immune system: possible implications for the development of asthma and atopy. J Allergy Clin Immunol. 2002;109 (6):923–8.PubMedCrossRefGoogle Scholar
  56. Wamboldt MZ, Laudenslager M, Wamboldt FS, et al. Adolescents with atopic disorders have an attenuated cortisol response to laboratory stress. J Allergy Clin Immunol. 2003;111:509–14.PubMedCrossRefGoogle Scholar
  57. Watamura SE, Donzella B, Kertes DA, Gunnar MR. Developmental changes in baseline cortisol activity in early childhood: relations with napping and effortful control. Dev Psychobiol. 2004;45:125–133.PubMedCrossRefGoogle Scholar
  58. Wilson IB, Cleary PD. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA. 1995;273:59–65.PubMedCrossRefGoogle Scholar
  59. Wright RJ, Finn P, Contreras JP, Cohen S, Wright RO, Staudenmayer J, et al. Chronic caregiver stress and IgE expression, allergen-induced proliferation, and cytokine profiles in a birth cohort predisposed to atopy. J Allergy Clin Immunol. 2004a;113 (6):1051–7.PubMedCrossRefGoogle Scholar
  60. Wright RJ, Cohen RT, Cohen S. The impact of stress on the development and expression of atopy. Curr Opin Allergy Clin Immunol 2004b;5:23–9.CrossRefGoogle Scholar
  61. Zupanic JAF, Gillie P, Streiner DL, Watts JL, Schmidt B. Determinants of parental authorisation for involvement of newborn infants in clinical trials. Pediatrics. 1997;99:213–6.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Clinical Investigations Unit, Department of Paediatrics and Child Health, Cork University HospitalUniversity College Cork (UCC)CorkIreland

Personalised recommendations