Determinants of Poor Health-Related Quality of Life in Patients With Food Allergy.

BACKGROUND: Food allergy (FA) significantly impairs health-related quality of life (HRQL), yet its key determinants remain unclear. This study aimed to identify factors associated with poor HRQL in FA using machine-learning analysis. METHODS: Within the Spanish multicentre BIOGRIAL study, well-phenotyped patients with IgE-mediated FA were enrolled. Participants aged ≥ 8 y were included to allow self-completion of the Food Allergy Quality of Life Questionnaire (FAQLQ). Clinical variables included atopic comorbidities, number and type of food allergies, age at onset, FA duration, need for urgent treatment, and reaction severity graded with the Food Allergy Severity Score. Poor FA-HRQL was defined as FAQLQ ≥ 5 (range 1-7). Determinants were identified using logistic regression and decision trees. RESULTS: A total of 502 patients were included (63.9% female, 86% adults, 7.4% adolescents, 6.6% children). Median FAQLQ was 4.55. Adults and females had poorer FA-HRQL than younger participants and males, respectively. Logistic regression identified female sex, multiple allergies, severe reactions, and vegetable allergy as independent predictors. Decision trees identified adult age, female sex, number of food allergies, need for urgent care, reaction severity, and FA onset < 18 y as determinants of poor FA-HRQL. Adult females with ≥ 7 food allergies had the worst FA-HRQL (mean FAQLQ 5.93), and 79% of patients with FAQLQ ≥ 5 were adult females. CONCLUSIONS: HRQL of people with FA is impaired by multiple determinants that should be addressed through psychosocial support, dietary management and education. Being female was the determinant with the highest negative impact, and adult women with multiple FAs have the poorest FA-HRQL and require targeted personalised interventions.