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  • 1.
    Jansson, S. -A
    et al.
    Karolinska Inst.
    Protudjer, J. L. P.
    Karolinska Inst.
    Heibert, M. Arnlind
    Karolinska Inst / Swedish Council Hlth Technol Assessment, SBU, Stockholm.
    Bengtsson, U.
    Sahlgrenska Univ Hosp, Gothenburg.
    Kallstrom-Bengtsson, I.
    Swedish Asthma & Allergy Fdn, Stockholm.
    Marklund, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Middelveld, R. J. M.
    Karolinska Inst.
    Rentzos, G.
    Sahlgrenska Univ Hosp, Gothenburg.
    Sundqvist, A. C.
    Södersjukhuset, Stockholm.
    Akerstrom, J.
    Sahlgrenska Univ Hosp, Gothenburg.
    Ostblom, E.
    Karolinska Inst.
    Dahlen, S. -E
    Karolinska Inst.
    Ahlstedt, S.
    Karolinska Inst.
    Socioeconomic evaluation of well-characterized allergy to staple foods in adults2014In: Allergy. European Journal of Allergy and Clinical Immunology, ISSN 0105-4538, E-ISSN 1398-9995, Vol. 69, no 9, p. 1241-1247Article in journal (Refereed)
    Abstract [en]

    Background: The aim of the present study was to evaluate if total, direct, indirect, and intangible costs differ between a cohort of adults with well-characterized allergy to staple foods ('cases') and controls. Methods: Swedish adults with objectively diagnosed food allergy to cow's milk, hen's egg, and/or wheat were recruited at an outpatient allergy clinic. Controls age- and sex-matched to cases were recruited from the same geographic area. For assessing the household costs of food allergy, a disease-specific socioeconomic questionnaire, developed within EuroPrevall, was utilized. Results: Overall annual total costs at the household level were significantly higher among adults with food allergy compared with controls (the difference amounted to 8164 (sic) ), whereas direct costs did not differ between cases and controls. However, household healthcare costs and costs for medicines were significantly higher for cases vs controls. Furthermore, indirect costs were significantly higher for households with food-allergic adults vs households without food-allergic adults. Specifically, more time was spent on performing domestic tasks due to a family member's food-allergy-related illness, as well as shopping and preparing food, and seeking food-allergy-related information. Presence of food allergy also affected intangible costs. Adults with food allergy experienced overall lower health status compared with controls. Conclusions: Swedish adults with allergy to staple foods have higher total costs determined as direct, indirect, and intangible costs using the disease-specific socioeconomic questionnaire. Thus, total costs were 8164 (sic) higher per year in households with at least one adult allergic to staple foods compared with controls.

  • 2.
    Jansson, Sven-Arne
    et al.
    The Centre for Allergy Research, Karolinska Institutet.
    Heibert-Arnlind, Marianne
    Swedish Council on Health Technology Assessment, SBU.
    Middelveld, Roelinde JM
    The Centre for Allergy Research, Karolinska Institutet.
    Bengtsson, Ulf J
    Sahlgrenska University Hospital.
    Sundqvist, Ann-Charlotte
    Sachs' Children and Youth Hospital.
    Kallström-Bengtsson, Ingrid
    The Swedish Asthma and Allergy Foundation.
    Marklund, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Rentzos, Georgios
    Sahlgrenska University Hospital.
    Åkerström, Johanna
    Sahlgrenska University Hospital.
    Östblom, Eva
    Sachs' Children and Youth Hospital.
    Dahlén, Sven-Erik
    The Centre for Allergy Research, Karolinska Institutet.
    Ahlstedt, Staffan
    The Centre for Allergy Research, Karolinska Institutet.
    Health-related quality of life, assessed with a disease-specific questionnaire, in Swedish adults suffering from well-diagnosed food allergy to staple foods2013In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 3, no 21Article in journal (Refereed)
    Abstract [en]

    Background

    Our aim was to investigate the factors that affect health related quality of life (HRQL) in adult Swedish food allergic patients objectively diagnosed with allergy to at least one of the staple foods cow’s milk, hen’s egg or wheat. The number of foods involved, the type and severity of symptoms, as well as concomitant allergic disorders were assessed.

    Methods

    The disease-specific food allergy quality of life questionnaire (FAQLQ-AF), developed within EuroPrevall, was utilized. The questionnaire had four domains: Allergen Avoidance and Dietary Restrictions (AADR), Emotional Impact (EI), Risk of Accidental Exposure (RAE) and Food Allergy related Health (FAH). Comparisons were made with the outcome of the generic questionnaire EuroQol Health Questionnaire, 5 Dimensions (EQ-5D). The patients were recruited at an outpatient allergy clinic, based on a convincing history of food allergy supplemented by analysis of specific IgE to the foods in question. Seventy-nine patients participated (28 males, 51 females, mean-age 41 years).

    Results

    The domain with the most negative impact on HRQL was AADR, assessing the patients’ experience of dietary restrictions. The domain with the least negative impact on HRQL was FAH, relating to health concerns due to the food allergy. One third of the patients had four concomitant allergic disorders, which had a negative impact on HRQL. Furthermore, asthma in combination with food allergy had a strong impact. Anaphylaxis, and particularly prescription of an epinephrine auto-injector, was associated with low HRQL. These effects were not seen using EQ-5D. Analyses of the symptoms revealed that oral allergy syndrome and cardiovascular symptoms had the greatest impact on HRQL. In contrast, no significant effect on HRQL was seen by the number of food allergies.

    Conclusions

    The FAQLQ-AF is a valid instrument, and more accurate among patients with allergy to staple foods in comparison to the commonly used generic EQ-5D. It adds important information on HRQL in food allergic adults. We found that the restrictions imposed on the patients due to the diet had the largest negative impact on HRQL. Both severity of the food allergy and the presence of concomitant allergic disorders had a profound impact on HRQL.

  • 3.
    Marklund, Birgitta
    et al.
    University of Kalmar, School of Human Sciences.
    Ahlstedt, Staffan
    Nordström, Gun
    Food hypersensitivity and quality of life2007In: Current Opinion in Allergy and Clinical Immunology, ISSN 1528-4050, E-ISSN 1473-6322, Vol. 7, p. 279-287Article, review/survey (Other academic)
  • 4.
    Marklund, Birgitta
    et al.
    University of Kalmar, School of Human Sciences.
    Ahlstedt, Staffan
    Nordström, Gun
    Health-related quality of life among adolescents with allergy-like conditions - with emphasis on food hypersensitivity2004In: Health and Quality of Life OutcomesArticle in journal (Refereed)
  • 5.
    Marklund, Birgitta
    et al.
    University of Kalmar, School of Human Sciences.
    Ahlstedt, Staffan
    Nordström, Gun
    Health-related quality of life in food hypersensitive schoolchildren and their families: parents' perceptions2006In: Health and Quality of Life OutcomesArticle in journal (Refereed)
  • 6.
    Marklund, Birgitta
    et al.
    University of Kalmar, School of Human Sciences.
    Gunnarsson, Nina
    Ahlstedt, Staffan
    Borell, Lena
    Nordström, Gun
    Allergy-like conditions and helath-care contacts among children with exclusion diets at school2005In: Scandinavian Journal of Caring Sciences, Vol. 19, p. 46-52Article in journal (Refereed)
  • 7.
    Marklund, Birgitta
    et al.
    University of Kalmar, School of Human Sciences.
    Wilde-Larsson, Bodil
    Ahlstedt, Staffan
    Nordström, Gun
    Adolescents' experiences of being food-hypersensitive: a qualitative study2007In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955Article in journal (Refereed)
  • 8.
    Protudjer, J. L. P.
    et al.
    Karolinska Inst.
    Jansson, Sven-Arne
    Karolinska Inst ; Umea Univ.
    Ostblom, E.
    Karolinska Inst ; Södersjukhuset Stockholm.
    Arnlind, M. Heibert
    SBU ;Karolinska Inst, Dept Learning Informat Management & Eth ; Karolinska Inst.
    Bengtsson, U.
    Sahlgrens Univ Hosp.
    Dahlen, S-E
    Karolinska Inst.
    Kallstrom-Bengtsson, I.
    Swedish Asthma & Allergy Fdn.
    Marklund, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Middelveld, R. J. M.
    Karolinska Inst ; Karolinska Inst.
    Rentzos, G.
    Sahlgrens Univ Hosp.
    Sundqvist, A. C.
    Södersjukhuset Stockholm.
    Akerstrom, J.
    Sahlgrens Univ Hosp.
    Ahlstedt, S.
    Karolinska Inst.
    Health-related quality of life in children with objectively diagnosed staple food allergy assessed with a disease-specific questionnaire2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 10, p. 1047-1054Article in journal (Refereed)
    Abstract [en]

    Aim: Among Swedish children of 0-12 years old, we investigated various food allergy-related exposures associated with health-related quality of life using a food allergy-specific questionnaire among children allergic to the staple foods cow's milk, hen's egg and/or wheat, and contextualised worse food allergy-associated health-related quality of life using a generic questionnaire versus controls. Methods: In total, 85 children with objectively diagnosed allergy to the staple foods were included as cases, and 94 children matched for age and sex were included as controls. We administered a food allergy-specific parent-completed questionnaire originally developed by EuroPrevall to cases only, and a generic health-related quality of life questionnaire (EuroQol Health Questionnaire, 5 Dimensions; EQ 5-D); to both cases and controls. Results: Hen's egg was the most common offending staple food, affecting 76% of cases. Approximately 7% of cases were allergic to all three staple foods. Parent-reported respiratory and cardiovascular symptoms were associated with worse health-related quality of life. Elements of disease severity [previous anaphylaxis (p < 0.001); epinephrine autoinjector prescription (p < 0.003)] were negatively associated with health-related quality of life. Cases had worse health-related quality of life measured by the EQ-5D compared to controls (p < 0.01). Conclusion: The use of a disease-specific questionnaire revealed that disease severity in children with objectively diagnosed allergy to the staple foods cow's milk, hen's egg and/or wheat is associated with worse health-related quality of life. The use of a generic questionnaire confirmed that cases have worse health-related quality of life than controls.

  • 9.
    Protudjer, Jennifer L. P.
    et al.
    Karolinska Inst, Sweden.
    Jansson, Sven-Arne
    Karolinska Inst, Sweden ; Umeå Univ, Sweden.
    Arnlind, Marianne Heibert
    Swedish Council Hlth Technol Assessment, Sweden ; Karolinska Inst, Sweden .
    Bengtsson, Ulf
    Sahlgrens Univ Hosp, Sweden.
    Källström-Bengtsson, Ingrid
    Swedish Asthma & Allergy Fdn, Sweden.
    Marklund, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Middelveld, Roelinde
    Karolinska Inst, Sweden.
    Rentzos, Georgios
    Sahlgrens Univ Hosp, Sweden.
    Sundqvist, Ann-Charlotte
    Sachs Children & Youth Hosp, Sweden.
    Åkerström, Johanna
    Sahlgrens Univ Hosp, Sweden.
    Östblom, Eva
    Sachs Children & Youth Hosp, Sweden ; Karolinska Inst, Sweden.
    Dahlen, Sven-Erik
    Karolinska Inst, Sweden.
    Ahlstedt, Staffan
    Karolinska Inst, Sweden.
    Household Costs Associated with Objectively Diagnosed Allergy to Staple Foods in Children and Adolescents2015In: Journal of Allergy and Clinical Immunology-In Practice, ISSN 2213-2198, Vol. 3, no 1, p. 68-75Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We previously reported that indirect and intangible costs burden households with a food allergic adult. We now extend our investigation to households with food allergic children and adolescents. OBJECTIVE: The objective of this study was to estimate direct, indirect, and intangible costs of food allergy in households with a child and/or adolescent with objectively diagnosed allergy to staple foods (cow's milk, hen's egg, and/or wheat), and to compare these costs with age-and sex-matched controls. METHODS: Direct and indirect cost parent-reported data collected via the Food Allergy Socio-Economic Questionnaire of 84 children (0-12 years) and 60 adolescents (13-17 years) with objectively diagnosed allergy to staple foods ("cases") and age- and sex-matched controls (n = 94 children; n = 56 adolescents) were compared. Annual household costs were calculated. Total household costs included direct plus indirect costs. Intangible costs included parent-reported health of their child and/or adolescent, standard of living, and perceptions of well-being. RESULTS: Amongst cases, total household costs were higher by (sic)3961 for children and (sic)4792 for adolescents versus controls (P < .05), and were driven by direct (eg, medications) and indirect (eg, time with health care professionals) costs. For children only, a history of anaphylaxis was associated with higher direct costs than no anaphylaxis ((sic)13,016 vs (sic)10,044, P < .05). Intangible costs (eg, parent-reported health of a child and/or adolescent) were significantly impacted amongst cases versus controls (P < .01). CONCLUSION: Households with a child and/or adolescent with objectively diagnosed allergy to staple foods have higher total household costs than controls. Direct and indirect costs were significantly higher for cases versus controls amongst children only. Amongst both age groups, such allergy adversely impacted intangible costs. (C) 2015 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.

  • 10.
    Protudjer, Jennifer Lisa Penner
    et al.
    Karolinska Institutet.
    Jansson, Sven-Arne
    Karolinska Institutet ; Umeå University.
    Middelveld, Roelinde
    Karolinska Institutet.
    Ostblom, Eva
    Karolinska Institutet ; Sachs Children & Youth Hosp, Södersjukhuset, Stockholm, Sweden.;Karolinska Inst, Södersjukhuset, Dept Clin Res & Educ, Stockholm.
    Dahlen, Sven-Erik
    Karolinska Institutet.
    Arnlind, Marianne Heibert
    SBU, Stockholm ; Karolinska Institutet.
    Bengtsson, Ulf
    Sahlgrens University Hospital, Gothenburg.
    Kallström-Bengtsson, Ingrid
    Swedish Asthma & Allergy Fdn, Stockholm.
    Marklund, Birgitta
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Rentzos, Georgios
    Sahlgrens University Hospital, Gothenburg.
    Sundqvist, Ann-Charlotte
    Sachs Children & Youth Hosp, Södersjukhuset, Stockholm.
    Åkerström, Johanna
    Sahlgrens University Hospital, Gothenburg.
    Ahlstedt, Staffan
    Karolinska Institutet.
    Impaired health-related quality of life in adolescents with allergy to staple foods2016In: Clinical and Translational Allergy, ISSN 2045-7022, E-ISSN 2045-7022, Vol. 6, article id 37Article in journal (Refereed)
    Abstract [en]

    Background: Cow's milk, hen's egg and wheat are staple foods in a typical western diet. Despite the ubiquity of these foods, the impact of staple food allergy on health-related quality of life (HRQL) amongst adolescents is incompletely understood. The aims of this study were to make use of the Swedish version of EuroPrevall's disease-specific food allergy quality of life questionnaire-teenager form (FAQLQ-TF) and to investigate the association between objectively-diagnosed staple food allergy and HRQL amongst adolescents. Methods: In this cross-sectional study, 58 adolescents aged 13-17 years [n = 40 (69 %) boys] with objectively-diagnosed allergy to the staple foods cow's milk, hen's egg and/or wheat and living in Stockholm, Sweden were included. Adolescents completed the FAQLQ-TF, which has a corresponding scale of 1 = best HRQL, and 7 = worst HRQL. Overall HRQL and domain-specific HRQL were established. Adolescents also reported symptoms, adrenaline auto injector (AAI) prescription and presence of other food allergies. A history of anaphylaxis was defined among those reporting difficulty breathing, inability to stand/collapse, and/or loss of consciousness. Clinically different HRQL was set at a mean difference of >= 0.5. Results: Overall mean HRQL was poorer than average [mean: 4.70/7.00 (95 % CI 4.30-5.01)]. The domain risk of accidental exposure was significantly associated with clinically better HRQL than the domain allergen avoidance and dietary restrictions (mean difference = 0.76; p < 0.001). Girls had clinically worse, but not statistically significantly different mean HRQL than boys (mean difference = 0.71; p < 0.07). HRQL tended to be worse amongst those with allergies to more than three foods or an AAI prescription. The number and types of symptoms, including a history of anaphylaxis were not associated with worse HRQL. Conclusions: As ascertained via a food allergy-specific questionnaire, adolescents with staple food allergy report poorer than average HRQL, specifically in relation to emerging independence and the need for support. Girls have clinically worse HRQL than boys. The number and type of previous symptoms and history of anaphylaxis were not associated with worse HRQL.

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