Validating the Finnish Child and Teen Versions of the Food Allergy Quality of Life Questionnaire

Food allergies can impair health-related quality of life (HRQoL) by causing anxiety about dietary avoidance and possible allergic reactions [1]. HRQoL is now a clinical core outcome on all food allergy clinical trials and interventional studies. The European Academy of Allergy and Clinical Immunology recommends using the Food Allergy Quality of Life Questionnaire (FAQLQ) to assess the HRQoL of people with food allergies [2]. Paediatric versions have been developed and validated, but not in Finnish [3, 4]. Our aim was to adapt and validate Finnish versions for children aged 8–15 years. The Tampere University Hospital Ethics Committee approved this study (number R21024) and parents of participants provided informed written consent prior to participation. The translation of the FAQLQ from English to Finnish was provided by Bertine Flokstra de Blok, PhD, the lead developer of the FAQLQ. The participants were children aged 8–15 years who had been referred to the paediatric allergology clinic at the Hospital between 2021 and 2024. All of them were on avoidance diets for suspected severe peanut or tree nut allergies. They completed the translated child (8–12 years) and/or teen (13–15 years) versions of the FAQLQ, plus the Food Allergy Independent Measure (FAIM). This has six HRQoL items and was specifically developed to validate the FAQLQ questionnaires [5]. The questionnaires followed the World Health Organization guidelines on translations and pre-testing with cognitive interviews. The 24-item child FAQLQ measures total food allergy quality of life [4] in four domains: allergen avoidance, risk of accidental exposure, emotional impact and dietary restrictions. The 23-item teen version [3] has three domains: risk of accidental exposure, emotional impact, and allergen avoidance and dietary restrictions. We assessed the construct validity of the FAQLQs and their domains and compared them with translated individual FAIM questions and summary scores. Spearman's correlation was used to calculate the correlation coefficients between the FAQLQ and FAIM questionnaires: < 0.4 was weak, 0.4–0.7 moderate and > 0.7 strong. The Mann–Whitney U test assessed differences in the total and domain scores of both FAQLQs, according to the participants' clinical characteristics: age, sex and anaphylaxis due to nut allergies. The questionnaires' internal consistency were evaluated using Cronbach's alpha coefficients and alpha values of 0.70–0.95 were adequate coefficients for reliability analysis. p < 0.05 were statistically significant. A total of 52 participants completed 57 separate FAQLQ questionnaires from 28 June 2021 to 8 September 2024. Five children completed both at different ages. Three quarters (75.4%) completed the child version at a mean age of 9.3 years, and 24.6% completed the teen version at a mean age of 14.0 years. Nearly half (46%) had experienced nut-related anaphylaxis. The child and teen versions showed excellent internal consistency for the total mean scores (Cronbach alpha 0.955 and 0.923, respectively) and the individual domains (Table 1). Cronbach's alpha also showed excellent reliability. The total mean score for the child version showed moderate and significant correlations to the mean FAIM score (rho 0.456, p = 0.002), but was weak and insignificant for two FAIM questions. The total mean score for the teen version showed strong and significant correlations to the mean FAIM score (rho 0.790, p < 0.001), with moderate to strong and significant correlations with all but one of the FAIM questions. When we compared the child version domains to the mean FAIM scores, we saw a moderate and significant correlation with the allergen avoidance, risk of adverse effects and emotional impact domains. The correlation of the dietary restrictions domain was weak, but significant (Table 1). All the teen version domains had strong and significant correlations with the mean FAIM scores. No discriminant validity was observed for anaphylaxis, sex or age. This study showed that both Finnish versions of the FAQLQ had excellent internal consistency and moderate-to-strong construct validity for measuring the impact of food allergies on HRQoL. These were the first allergen-specific HRQoL questionnaires for Finnish children and teens that had been validated according to the World Health Organisation (WHO) guidelines, and they were authorised by the FAQLQ series developers. The major strengths of the study were that we included children with the greatest risk of life-threatening nut allergies and the study translations followed the WHO guidelines. It also had some limitations, including some selection bias, as all the participants had nut allergies. In addition, the number of completed teen questionnaires was relatively low. The validity of the English-language versions of the questionnaires was proven. However, cultural differences may have influenced the ability of the questionnaire to identify essential items for Finnish-speaking patients. This risk was minimised by using cognitive interviews to pre-test the instrument, according to the WHO guidelines. The Finnish child and teen FAQLQ versions demonstrated excellent internal consistency and moderate-to-strong construct validity, which were similar to the original development studies. They can now be used in clinical and research practice, alongside the previously validated Finnish parent version. We thank Hazel Sorsamo for the back translations and nurses Auli Silvonen, Milja Tarvainen and Sanna Koskinen for recruiting the cohort. Open access publishing facilitated by Tampereen yliopisto ja Tampereen ammattikorkeakoulu, as part of the Wiley - FinELib agreement. The authors declare no conflicts of interest. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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