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Sex or gender may play a role in how food allergies impact a patient's health-related quality of life (QoL), a systematic review of dozens of studies suggested.

Strong evidence from non-interventional studies indicated that female patients experiencing food allergies self-reported poorer health-related QoL scores compared with their male counterparts. This applied to both adult and pediatric patients, according to Mimi Tang, MBBS, PhD, of Murdoch Children's Research Institute in Parkville, Australia, and coauthors.

Among interventional pediatric studies, one study reported a strong association between a participant's sex and their health-related QoL across all the included measurements, indicating that boys ultimately saw greater health-related QoL improvement compared with girls.

The three studies that included immunotherapy also showed sex disparities in health-related QoL between the time of baseline measurements and follow-up, the study in showed.

Overall, the studies included in the systematic review supported relationships between patient sex or gender and self-reported caregiver proxy-reported health-related QoL, a caregiver's self-reported health-related QoL, as well as proxy-reported health-related QoL.

"Our objective in publicizing this research is to highlight the need to account for gender when caring for people with food allergy, when measuring the impact of food allergy on quality of life, and when making policy decisions about food allergy," said Tang in a press release.

Caution is warranted when interpreting the findings, however.

Sayantani Sindher, MD, of Stanford Medicine Healthcare in Palo Alto, California, told 番茄社区app via email that there needs to be more sufficient evidence to determine a sex bias in food allergy QoL outcomes.

Regarding immunotherapy trials, "it should be noted that most studies actually reported no sex/gender differences in quality-of-life outcomes," she explained. "Further studies are needed to assess whether this is a general bias in quality-of-life reporting or whether it is actually the case that females are more heavily impacted by food allergy than males."

Notably, the study authors acknowledged that all but one study in their report had either a serious or critical risk of bias rating.

Tang and colleagues had identified 34 studies for their analysis, 10 interventional and 24 non-interventional. One study examined health-related QoL for all ages, five examined health-related QoL for adults with food allergies, 28 examined pediatric patients, and seven featured questions addressing a caregiver's health-related QoL. All studies with interventions were conducted in pediatric patients.

In non-interventional studies, poorer baseline QoL scores were reported in both girls and women compared with boys and men. Two studies saw worse physical subdomain health-related QoL in female patients, whereas one study saw no sex-based differences.

Sex differences in both dietary risk and emotional impact were somewhat common in studies that utilized Food Allergy Quality of Life Questionnaires. In these studies, there was little association seen between the child's or caregiver's sex/gender and a caregiver proxy-reported QoL.

"The heterogeneity in results obtained from included studies emphasizes the relationship between gender and HRQL [health-related QoL] in populations with a food allergy is complex and likely limited by variation in HRQL instruments applied and narrow considerations of gender," the authors wrote.

Sindher stressed the need for more standardized tools to measure treatment impacts and overall QoL in patients with food allergy, as well as in their caregivers.

Another major limitation of the study, Tang's team said, was that it only addresses male and female participants, which they stated addresses only "a narrow definition of gender, with all studies defining sex or gender constructs according to the same biologically determined binary."

Researchers encouraged further, more diverse, research to address potential disparities.

"This study highlights the need for purposeful consideration of a diversity of gender identities, ages and allergens in future investigations of HRQL to establish whether psychosocial experience or biological factors drive differences in food allergy outcomes," they wrote.

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