Peanut allergy (PA) is usually lifelong and known to affect quality of life (QoL). The APPEAL study evaluated the psycho-social impact of PA on patients and their parents/caregivers. APPEAL was a quantitative European online 30-minute survey, conducted in 8 European countries (Denmark, France, Germany, Ireland, Italy, Netherlands, Spain, UK). Adults with PA and parents/caregivers of individuals with PA were eligible to participate in the study (self-report). Parents/caregivers could also fill out a questionnaire on behalf of PA individuals for whom they cared. A total of 1846 responses were analyzed. 1300 participants completed the survey: adults with PA (n=419, self-reporting), and parents/caregivers of a person with PA (n=881, self-reporting). Sixty-two percent of parents/caregivers also completed a questionnaire, on behalf of a PA individual (n=546, proxy-reporting). 39.8% (n=735) felt frequently or very frequently frustrated by the limitations and restrictions of living with PA, and 28.2% (n=521) reported being somewhat frequently frustrated. Furthermore, 39.9% (n=736) reported high or extremely high level of uncertainty of living with PA. Regarding the stress due to living with PA, 39.9% (n=737) experienced an extremely high or high level of stress. These findings are consistent through the different European countries. APPEAL, the first multidimensional pan-European online survey, specifically designed to study the psycho-social burden of PA on individuals' lives and on their families, revealed that across the European countries studied, participants are experiencing a high level of frustration, stress, and uncertainty in everyday life when managing their PA using avoidance.

Precautionary allergen labelling (PAL) was introduced by the food industry to help manage and communicate the possibility of reaction from the unintended presence of allergens in foods. However, in its current form, PAL is counterproductive for consumers with food allergies. This review aims to summarize the perspectives of all the key stakeholders (including clinicians, patients, food industry and regulators), with the aim of defining common health protection and risk minimization goals. The lack of agreed reference doses has resulted in inconsistent application of PAL by the food industry and in levels of contamination that prompt withdrawal action by enforcement officers. So there is a poor relationship between the presence or absence of PAL and actual reaction risk. This has led to a loss of trust in PAL, reducing the ability of consumers with food allergies to make informed choices. The result has been reduced avoidance, reduced quality of life and increased risk-taking by consumers who often ignore PAL. All contributing stakeholders agree that PAL must reflect actual risk. PAL should be transparent and consistent with rules underpinning decision-making process being communicated clearly to all stakeholders. The use of PAL should indicate the possible, unintended presence of an allergen in a consumed portion of a food product at or above any proposed action level. This will require combined work by all stakeholders to ensure everyone understands the approach and its limitations. Consumers with food allergy then need to be educated to undertake individualized risk assessments in relation to any PAL present.