The APPEAL-2 Study: Peanut Allergy Significantly Impacts Quality Of Life

Learn what the findings from the APPEAL-2 study reveal about quality-of-life impacts of living with a peanut allergy, for both peanut allergic children and their caregivers. 

Peanut allergy is one of the most common childhood food allergies, and it is usually lifelong. And compared to other food allergies, peanut  allergies more commonly cause severe or life-threatening allergic reactions. Because of these factors, peanut allergies significantly impact the quality of life for people who live with them.

Aimmune’s APPEAL-2 study (Allergy to Peanuts ImPacting Emotions And Life-2) investigated the specific ways a peanut allergy impacts quality of life for: 

  • 107 young people (4-17 years old) and their caregivers 
    • 24 children ages 8-12, 39 teenagers, and 44 caregivers of 4-17 year olds
    • From 8 European countries (the United Kingdom, France, Germany, Ireland, Spain, Italy, Denmark, and the Netherlands)
    • All had (or cared for someone with) moderate or severe peanut allergy

Today, we’ll cover the most significant findings from APPEAL-2, including how:

  • Peanut allergies commonly cause fear and anxiety.
  • Around one-third of young people with peanut allergy choose not to disclose it, out of fear of embarrassment or bullying.
  • Many young people avoid social activities, and often feel left out, due to their allergy.
  • Around half of young people said their peanut allergy has negatively affected friendships.
  • Several young people are bullied due to their peanut allergy.
  • More than a third of caregivers thought that their child’s peanut allergy negatively affected their career, due to reducing working hours or taking time off to protect their child.


The new APPEAL-2 study is the largest  European qualitative study to examine the impact of peanut allergies on children’s and teens’ quality of life. It’s also the largest quality-of-life study to examine specific impacts of peanut allergy, rather than looking at food allergies as a whole.

Like its predecessor, the APPEAL-1 study,  APPEAL-2 shows that the fear of accidental exposure to peanut has significant negative impacts on the social and emotional well-being of young people with peanut allergies. This fear also has a significant emotional impact on these children’s caregivers.

As  Daniel Adelman, M.D., Chief Medical Officer at Aimmune, shared with Business Wire, “The results of APPEAL-2 reinforce the findings of APPEAL-1 and further underscore that peanut-allergic individuals are more likely to experience feeling different, isolated, and restricted from social activities than their peers; their caregivers more often experience stress and adverse impacts on work and career. Both peanut-allergic individuals and caregivers experience anxiety, worry, sadness, and annoyance, and reported their lives are adversely affected by peanut avoidance, accidental reactions to peanuts, and the fear of reacting to peanuts.”

What is the difference between this new study and APPEAL-1? The earlier APPEAL-1 was a quantitative study. It collected data on the percentages of children who suffered specific quality-of-life impacts, through a survey. But this new APPEAL-2 study revolved around 30-50 minute interviews with peanut allergic young people and their caregivers, to gain a bigger picture of their allergy’s impact on their well-being. Then, researchers searched through the interviews to find the most common shared experiences of living with peanut allergy.

Here are some of the most significant findings from APPEAL-2:

APPEAL-2 Findings: Young People with Peanut Allergies 

Emotional Impacts

  • The most common emotional impact of peanut allergy was anxiety, worry, or fear surrounding a possible allergic reaction.
  • Other common emotions caused by peanut allergies included “frustration, annoyance, sadness, disappointment, stress, embarrassment, and feeling different from others.”
  • Several children shared worries about entering new environments, or possibly coming into contact with someone who had eaten peanuts.
  • Many teens reported being fearful of having to use their Epi-Pen, or worried that it might not work.

Learn more about how food allergies can significantly affect a child’s quality of life: 

Disclosing Peanut Allergy

  • One-third of children, and some teenagers, didn’t want others to know about their peanut allergy, so they purposely chose not to disclose it, even though not disclosing it could threaten their safety.
    • Some chose not to disclose their peanut allergy because of embarrassment.
    • Others were afraid that peers would tease or bully them if they disclosed their allergy. 
  • Some teenagers felt  “self-conscious, awkward, or embarrassed when disclosing their peanut allergy,” and said this was one of the hardest parts of living with a peanut allergy.

Eating Out and Social Events 

  • Many children and teenagers use “avoidance” as a peanut allergy management strategy. 
    • They avoid not only restaurants, but other social spaces (like movie theaters and activities with friends), causing them to miss out.
  • Children and teenagers often felt left out, since they could not attend social events or share food with others.
  • Most teenagers shared negative experiences of going to restaurants with friends.
    • Some were embarrassed at having to disclose their allergy in front of friends. 
    • Others were treated unkindly by restaurant staff.

Friendships, Socialization, and Bullying

  • Around half of the children and teenagers said their peanut allergy caused negative effects on their friendships.
  • Many children and teens shared that their peanut allergy made them feel different from others, in a negative way.
  • Several young people shared that they were teased or bullied because of their peanut allergy.

APPEAL-2 Findings: Caregivers

 Food Preparation

  • The most time-consuming aspect of managing a child’s peanut allergy for caregivers was buying and preparing safe foods for their child.

Eating Out and Social Events

  • Determining safe restaurants and other places to eat outside the home for their child was a major caregiver concern.
  • Many caregivers mentioned checking the distance from a restaurant to a hospital or pharmacy, in case of a peanut allergy emergency. 
  • When it came to social events, checking with a host or caterer about food options, and reminding the host about their child’s allergy, created a large burden.
  • Almost a quarter of caregivers preferred to skip social events where they had no control over the environment, or where they knew peanuts would be served.
  • Some parents would not allow children to attend social events on their own, or require children to skip social events.

Impacts on Caregivers’ Work

  • Around a quarter of caregivers shared that they reduced working hours away from home, or worked part-time so they could prepare their child’s lunch at home, to reduce the risk of a peanut allergy reaction.
  • Also, around a quarter of caregivers needed to take time off work due to a child’s peanut allergy. Some allergy-related reasons for taking off work included allergist appointments and to supervise their child during school trips.
  • More than a third of caregivers thought that their child’s peanut allergy negatively affected their career, due to reducing working hours or taking time off. This emphasizes the socioeconomic impact that peanut allergies can have on families.

Anxiety About Protecting Their Child

  • Nearly half of caregivers said they worried about having less control over their child’s food and environment as their child becomes more independent, and thus being less able to protect them from an allergic reaction.
  • Many caregivers reported being fearful of using an Epi-Pen to protect their child, or worried that it might not work.

Lessening the Burden of Peanut Allergies

Young people and their caregivers also shared ways that their communities can help lessen their burden of living with a peanut allergy. These were their thoughts:

  • Educating both healthcare professionals and the general public about peanut allergies, to increase their awareness and understanding of these allergies, is crucial.
  • Food allergy clinics should include psychological services to improve peanut allergy care, because of how significantly peanut allergy impairs quality of life.
  • Clear, meaningful labeling of foods that contain common allergens is vital wherever someone can purchase food. 
    • Sometimes, “may contain peanut” or “may contain traces of peanut” labeling can be confusing.
  • Food allergic individuals and caregivers need clear information  on how to use an Epi-pen in an emergency, so they can respond to a severe reaction with more confidence.
    • They would also benefit from clearer information on what causes an allergic reaction. 

APPEAL-2 Study: Key Takeaways for Parents

  • People with peanut allergies often feel stressed, anxious, and embarrassed. 
  • The need to avoid peanuts often keeps young people from participating in social events, and can lead them to feel left out.
  • Sometimes, peanut allergies negatively affect children’s friendships. 
  • Fear of embarrassment or teasing sometimes keeps young people from disclosing their peanut allergy—even though this choice could put them in danger.
  • Children with peanut allergies are often bullied due to their allergies. 
  • Living with peanut allergies can create financial burdens for families, because caregivers often reduce work hours or take time off due to their child’s allergy.

How can parents help prevent peanut allergies in babies?

Fortunately, as recent landmark clinical studies (like the LEAP study) have shown, there’s a way to help prevent peanut allergies before they start. 

Introducing common allergy-causing foods like peanut to your baby early and often is the best way to reduce your child’s risk of developing an allergy to these foods. 

  • Introduce peanut starting as early as 4-6 months of age, and before your baby turns one. Earlier is better.
  • Consistently feed baby peanut 2-7 times a week for 3-6+ months. Sustained exposure is just as vital for prevention as starting early.


All health-related content on this website is for informational purposes only and does not create a doctor-patient relationship. Always seek the advice of your own pediatrician in connection with any questions regarding your baby’s health.

These statements have not been evaluated by the Food and Drug Administration. Products are not intended to diagnose, treat, cure or prevent any disease.

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