Factors determining parents' perception of their child's risk of life-threatening food-induced anaphylaxis

Background: Although food allergy is known to be associated with increased disease burden, factors shaping parents' perception of their child's risk of future severe or fatal anaphylaxis are poorly understood.

Objective: This study aimed to evaluate factors associated with parents' perceived risk of food-induced anaphylaxis.

Methods: A questionnaire-based survey of 202 parents was conducted in a single specialist centre outpatient clinic treating children with food allergies. Parents' perceived risk of their child experiencing further food-induced anaphylaxis was assessed using a validated Food Allergy Independent Measure. Demographic data, as well as parents' anxiety, and depression scores were assessed using Hospital Anxiety and Depression Score.

Results: Nineteen percent of parents felt their child had a moderate to high chance of dying from food-induced anaphylaxis. Lack of a university education, higher anxiety score and particularly possession of an epinephrine auto-injector (relative risk 9.9 (3.3 - 30)) were key factors associated with heightened risk perception. Caring for a child with multiple food allergies was the main factor associated with parents feeling less able to manage future reactions (relative risk 9.5 (1.7 - 53)). Parents' risk perception of fatal anaphylaxis correlated with anxiety and mood scores.

Conclusion: Parents' education, affect and possessing an epinephrine auto-injector were associated with a heightened perceived risk of future anaphylaxis. Clinicians should consider not only the child's needs, but also providing counselling for parents, particularly those possessing auto-injectors. Parents of children with multiple food allergies may need additional education and training to help them cope with future reactions.