Management of nut allergy influences quality of life and anxiety in children and their mothers Peanut and tree nut allergy are a major health concern in the developed world. Twenty years ago peanut allergy was considered rare, with only a few case reports, but since then the prevalence of this allergy has risen substantially. Whilst 0.5% of four year olds born on the Isle of Wight in 1989 had suffered an allergic reaction to peanut, 1.6% of 4 year olds born 5 yrs later were diagnosed with peanut allergy(1). Peanut allergy can result in life threatening reactions and there is currently no cure. Current best practice dictates that children with nut allergy should be looked after by a specialist team and should all be given a management plan (2, 3). The treat- ment for anaphylaxis is prompt intramuscular injection of epinephrine (4). Delayed administra- tion can be associated with death and therefore patients are educated in the use of epinephrine Cummings AJ, Knibb RC, Erlewyn-Lajeunesse M, King RM, Roberts G, Lucas JSA. Management of nut allergy influences quality of life and anxiety in children and their mothers. Pediatr Allergy Immunol 2010: 21: 586–594. Ó 2010 John Wiley & Sons A/S Nut allergy is known to impact on the quality of life (QoL) and anxiety of both the allergic child and their parents, but little is known about how the management of food allergy is associated with these variables. To investigate the impact of nut allergy on QoL and anxiety in mothers and children with nut allergy in order to identify management strategies that may influence these factors. Forty-one nut allergic children (age 6– 16 yrs) and their mothers completed questionnaires to assess maternal and childrenÕs QoL (PedsQLÔ, WHOQOL-BREF, FAQL-PB), anxiety (SCAS, STAI) and perceived stress scale (PSS). Children also completed a nut allergy specific QoL questionnaire. Demographic data, details of previous reactions, test results and management plans were collected using parent-report questionnaires and hospital notes. Children with nut allergy had poorer emotional (p = 0.004), social (p = 0.043), and psychological (p = 0.006) QoL compared to healthy normative data. Maternal and child QoL and anxiety were not influenced by the severity of previous reactions. Mother and child reported lower anxiety (p = 0.043 and p < 0.001 respectively) when the child was prescribed an epinephrine auto-injector. Anxiety was not associated with whether the child carried the auto-injector or whether they strictly avoided traces of nuts in foods. Prescribing auto-injectors is associated with reduced anxiety for food allergic children and their mothers, but is not associ- ated with improved adherence with medical management or reduced risk-taking behavior. Amanda J. Cummings 1 , Rebecca C. Knibb 2 , Michel Erlewyn-Lajeunesse 1,3 , Rosemary M. King 3 , Graham Roberts 4 and Jane S. A. Lucas 1 1 Infection Inflammation and Immunity, School of Medicine, University of Southampton, Southampton, UK, 2 University of Derby, Derby, UK, 3 Southampton University Hospitals NHS Trust, Southampton, UK, 4 Developmental Origins of Health and Disease, School of Medicine, University of Southampton, UK Key words: peanut allergy management; quality of life; anxiety Jane Lucas, Infection Inflammation and Immunity, Child Health (MP 803), Southampton University Hospitals NHS Trust, Tremona Road, Southampton, UK. SO16 6YD Tel.: +44(0)23 80 796160 Fax: +44(0)23 80 798847 E-mail: jlucas1@soton.ac.uk Funding: None Accepted 12 October 2009 Abbreviations: FAQL-PB, Food Allergy Quality of Life- Parental Burden Questionnaire; FAQLQ-PF, Food Allergy Quality of Life- Parent Form; PedsQL, Pediatric QoL Inven- tory 4.0; PSS-14, Perceived Stress Scale-14; QoL, Quality of Life; SCAS, Spence Child Anxiety Scale; SPT, Skin Prick Test; STAI, State- Trait Anxiety Inventory; WHOQOL-BREF, World Health Organization QoL Scale. Pediatr Allergy Immunol 2010: 21: 586–594 DOI: 10.1111/j.1399-3038.2009.00975.x Ó 2010 John Wiley & Sons A/S PEDIATRIC ALLERGY AND IMMUNOLOGY 586