Abstract
INTRODUCTION: Preschool oral immunotherapy (OIT) is safe and effective for food allergy, and may improve parental food allergy-specific anxiety (FAA) and food allergy quality of life (FAQL); however, data on these important outcomes are limited, particularly for preschoolers. Herein, we explored the relationship between OIT and parental FAA, including the subdomains: food allergy-related worries, anxiety impact, behavioural avoidance, and coping; and OIT and FAQL in parents of preschool-aged children. METHODS: Parents of preschool-aged children (< 72 months) receiving OIT in Canadian allergy clinics were eligible for this observational study. The Impairment Measure for Parental Food Allergy-Associated Anxiety and Coping Tool (IMPAACT) and the Food Allergy Quality of Life-Parental Burden (FAQL-PB) questionnaire were administered to parents at four timepoints from the start of OIT to 12 months post-build-up. The relationships between OIT and total FAA, each IMPAACT subscale, and FAQL were investigated using a series of linear mixed effect models. Each model included variables related to child age, whether child was receiving OIT to some (partial OIT) or all of (complete OIT) their allergens, time to complete build-up, and two binary variables indexing whether the child experienced a reaction during build-up or maintenance. RESULTS: Between 2021 and 2025, 788 children participated. Total IMPAACT scores decreased during OIT build-up, indicating improvement (baseline: 70.69; end of build-up: 57.36; marginal mean change: -13.33; b = -18.13; 95% CI = -27.63, -8.62, p < 0.001). IMPAACT scores significantly decreased across three subscales: Worries; anxiety impact, and behavioural avoidance. FAQL-PB scores decreased during OIT build-up (baseline: 27.35; end of build-up: 22.16; marginal mean change: -5.19; b = -7.17; 95% CI = -12.65, -1.69, p = 0.01). Child's age, partial versus complete OIT, time to complete build-up, and reactions during maintenance moderated the relationship between time and some of the outcome variables. CONCLUSION: Preschool OIT is associated with significant improvements in parent food allergy-specific anxiety and food allergy quality of life.