In a recent systematic review published in Clinical & Experimental Allergy, researchers examined the correlation between health-related quality of life (HRQL) and biological sex among individuals with immunoglobulin E (IgE)-related food allergies and their care providers.
Background
Food allergies have a significant impact on individuals and their caregivers, resulting in worse health-related quality of life (HRQL) due to tight dietary restrictions, a lack of treatment alternatives, and the fear of unintentional exposure. Previous studies have reported on the mental well-being and lifestyle implications of food allergy patients and their families but have considered only a subset of patient demographics, specifically gender.
Understanding the characteristics that influence HRQL is critical for tailored food allergy care, yet there are discrepancies about the role of biological sex on HRQL outcomes among individuals with food allergies. Caregivers, particularly mothers, frequently carry the responsibility of managing food allergy-related anxiety, and mothers are over-represented in food allergy literature, which is most likely owing to gender differences in parenting.
About the systematic review
In the present systematic review, researchers examined gender-specific health-related quality of life (HRQL) measurements among food allergy patients, comparing them to those of parents and participants. They also investigated the influence of gender on allergen prevention and treatment.
The team searched the Embase and Medline databases on April 4, 2022, updating them on December 5, 2023, including records from the APA PsycINFO database. The included studies were interventional or non-interventional studies published in English, reporting original research on the relationship between biological sex and health-associated life quality, as assessed using validated instruments, among individuals with immunoglobulin E-mediated food allergies.
The team excluded studies evaluating HRQL among individuals with non-IgE-related food allergies and multiple allergies. They also excluded narrative reviews, case studies, gray literature, conference abstracts, opinion pieces, and systematic reviews. Study interventions included educational, medicinal, and psychological types. In cases of undocumented health-associated life quality scores for sex-stratified subgroups, the team extracted p-values denoting HRQL differences in females vs. males.
Two researchers independently screened titles and abstracts before full-text review to confirm eligibility. The team used the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) to assess study quality and the ROBINS-E tool to conduct sensitivity analyses for non-interventional records. They evaluated bias risks using traffic light plots.
Results
Initially, the team identified 4,799 studies, of which 3,927 underwent title-abstract screening, 426 underwent full-text screening, and 34 studies (24 non-interventional and 10 interventional) were analyzed. Researchers used several HRQL instruments in the included studies, of which the age-specific Food Allergy Quality of Life Questionnaire (FAQLQ) was the most frequent, revealing sex-based differences in subdomains associated with emotional impact and dietary risk.
Female participants with food allergies (63% of studies with pediatric participants, 83% of studies with adult participants) and the maternal parents of individuals with food allergies (50% of caregiver studies) reported poorer health-related quality of life than their male counterparts, irrespective of age, especially in emotional, physical, and food anxiety-associated wellness domains. The team observed sex-based disparities in child health-related quality of life following food allergen immunological therapy. However, selective documentation in the interventional studies indicated that the directional course of the association was unclear.
Caregiver gender did not impact the proxy-documented health-related quality of life of the study participants, nor did the biological sex of the child affect the caregiver’s health-related quality of life. All studies, except one, received critical to serious bias risk ratings in ROBINS-I evaluations. The most frequent bias sources in the included studies were related to HRQL measurements due to investigators and study participants being aware of interventions and exposure statuses and through inconsistent or inadequate confounding factor considerations. Sensitivity analysis found slight differences in bias risk classifications of poorer quality in four studies of the non-interventional type, as assessed using the ROBINS-E tool, for insufficient consideration of primary bias sources.
Conclusions
Overall, the review findings highlighted the impact of gender on HRQL in IgE-related food allergies, with female adults and children reporting lower baseline overall HRQL and mothers experiencing lower subdomain HRQL. The findings emphasize the necessity for personalized allergy treatment techniques and stratifying HRQL outcomes by gender in allergen immunotherapy studies.
In food allergy investigations, biological sex should be considered a factor influencing participant overall and domain-specific HRQL outcomes. Females with food allergies had lower baseline HRQL total scores than males, with comparable gender disparities across HRQL subdomains.
The study reveals that an interaction between gender and allergen type may influence HRQL results following therapy. Future studies should concentrate on gender in HRQL to lessen reliance on subgroup and sensitivity analysis.
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