Self-administration of adrenaline for anaphylaxis during in-hospital food challenges improves health-related quality of life

Sarah Burrell, Nandinee Patel, Marta Vazquez-Ortiz, Dianne E Campbell, Audrey DunnGalvin, Paul J Turner, Sarah Burrell, Nandinee Patel, Marta Vazquez-Ortiz, Dianne E Campbell, Audrey DunnGalvin, Paul J Turner

Abstract

Objective: To assess the impact of anaphylaxis on health-related quality of life (HRQL) and self-efficacy in food-allergic patients undergoing in-hospital food challenge.

Design: Secondary analysis of a randomised controlled trial.

Setting: Specialist allergy centre.

Patients: Peanut-allergic young people aged 8-16 years.

Interventions: Double-blind, placebo-controlled food challenge to peanut, with HRQL and self-efficacy assessed using validated questionnaire, approximately 2 weeks prior to and 2 weeks after challenge. Where possible, anaphylaxis was treated with self-injected adrenaline (epinephrine).

Main outcome measures: Change in HRQL and self-efficacy.

Results: 56 participants had reactions at food challenge, of whom 16 (29%) had anaphylaxis. Overall, there was an improvement in HRQL (mean 2.6 points (95% CI 0.3 to 4.8); p=0.030) and self-efficacy (mean 4.1 points (95% CI 2.4 to 5.9); p<0.0001), independent of whether anaphylaxis occurred. Parents also reported improved HRQL (mean 10.3 points (95% CI 5.9 to 14.7); p<0.0001). We found evidence of discordance between the improvement in HRQL and self-efficacy as reported by young people and that perceived by parents in their child.

Conclusions: Anaphylaxis at food challenge, followed by self-administration of injected adrenaline, was associated with an increase in HRQL and self-efficacy in young people with peanut allergy. We found no evidence that the occurrence of anaphylaxis had a detrimental effect. Young people should be encouraged to self-administer adrenaline using their autoinjector device to treat anaphylaxis at in-hospital challenge.

Trial registration number: NCT02149719.

Keywords: adolescent health; therapeutics.

Conflict of interest statement

Competing interests: PT has received research funding for studies of food desensitisation from the Medical Research Council, Imperial/NIHR Biomedical Research Centre, Jon Moulton Charity Trust and Action Medical Research and has acted a principle investigator for commercial studies of food immunotherapy sponsored by Aimmune Therapeutics and DBV Technologies. DC is an employee of DBV Technologies. The other authors declare that they have no conflicts of interest.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.

Figures

Figure 1
Figure 1
Change in HRQL in the participant (FAQLQ-YP), parent proxy (FAQLQ-P) and the parent themselves following food challenge, overall and by reaction severity. Error bars represent 95% CIs. FAQLQ, Food Allergy Quality of Life Questionnaire; HRQL, health-related quality of life.
Figure 2
Figure 2
Change in self-efficacy score reported by participants and parent proxy (ie, change in the young person as reported by the parent). Error bars represent 95% CIs.

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