In our study, in an engaged patient population at a food allergy educational symposium, adolescents had significantly lower QoL than children, reflected by higher FAQLQ scores despite having fewer FA. Teens generally reported more concern about their disease and more reassurance by epinephrine carriage than children, which may be due to their increased autonomy regarding their health. These findings underscore that engagement in food allergy symposia does not dilute the effect shown in prior studies demonstrating that older children, ages 6–12 years, have worse QoL compared to children 0–5 years [6]. Miller et al. also found that increased age was associated with worse SDLs and EI [5]. As children mature and have less parental supervision, they have greater personal responsibility for their health which may lead to poorer QoL [5, 6].

FA teenagers have reported struggling in school, depression, and social isolation as a result of their disease [4, 7]. As teenagers mature, they have greater appreciation of the reality of having a lifelong disease [3, 4]. In addition, the need to create and maintain a FA free environment can make teens feel singled out [7]. For example, up to 24% of FA teenagers and adults report being bullied for their FA at some point during their life, including intentional contamination of their lunches with their allergenic food [3, 4]. Having a chronic condition that requires constant vigilance during a time of intense physical and emotional growth likely worsens QoL, which may explain the difference seen in our study between children and teenagers.

Despite lower QoL scores, in our study, adolescents had lower FAIM scores reflecting less anxiety about accidental food exposure. This may be due to more engagement in educational opportunities, increased experience at avoiding allergenic foods, or differences in parental and adolescent perceptions of risk of unintentional allergen ingestion. Furthermore, adolescents in this study had less FA than children, decreasing the burden of needing to avoid multiple foods. Given the influence of FA on patient and family QoL, education on FA may decrease anxiety. Group FA education and training has been shown to improve parental QoL [2]. Providing families with tools to manage FA can foster coping mechanisms.

The higher incidence of dysphagia in teenagers may indicate eosinophilic esophagitis (EoE) as an under-recognized cause of dysphagia among FA youth. This may have contributed to a worse QoL. Dysphagia is a common manifestation of EoE in older children. EoE is a FA-associated chronic disease with inflammatory responses to food antigen, and > 90% of EoE patients will respond to an elimination diet that avoids identifiable trigger foods. Symptoms of the disease often recur with re-introduction of the identified trigger foods. The incidence of EoE in FA pediatric patients has been reported to be higher than in the general population with estimates of around 100-fold higher than the non-FA population [9]

Our study has several limitations. First, our participants were recruited at an educational symposium, which may select for patients who are more concerned about their FA. Second, there were a small number of adolescent patients. Also, there may be differences between adolescents and children due to parental reports (proxy report) for young children.