Welcome to the

QoL Questionnaire

Food Allergy Quality of Life Questionnaire-Parent Form (FAQLQ-PF) (Shortened Version) for
Parents of children aged 0-17 years

Instructions to Parents

The following are scenarios that parents have told us affect children’s quality of
life because of food allergy/ anaphylaxis /eczema/drug allergy.

Please indicate how much of an impact each scenario has on your child’s quality
of life by placing a rating of 0 to 6.

Response Options

1 = not at all, 2 = a little bit, 3 = slightly, 4 = moderately, 5 = quite a bit, 6 = very much, 7 = extremely

not at all

extremely

All information given is completely confidential. This questionnaire will only be
identified by a PASSCODE number provided by T E A C H.

All the fields are required

    Because of anaphylaxis/food allergy/drug allergy/eczema/chronic hives my child('s)...

    Feels different from other children

    • Not at all

    • Extremely

    Is afraid to try unfamiliar foods/new medications

    • Not at all

    • Extremely

    Experiences physical and/or emotional distress

    • Not at all

    • Extremely

    Has a lack of variety in his/ her diet

    • Not at all

    • Extremely

    Social environment is restricted because of limitations on restaurants and/or holiday destinations we can safely go to as a family

    • Not at all

    • Extremely

    Ability to take part in social activities (sleepovers, parties, playtime, etc.) has been limited

    • Not at all

    • Extremely

    Feels concerned when going to unfamiliar places

    • Not at all

    • Extremely

    Feels frustrated by restrictions on social activities (e.g. need to plan ahead; need to carry autoinjector)

    • Not at all

    • Extremely

    Is more cautious and /or concerned in general than other children of his/her age

    • Not at all

    • Extremely

    Wishes his/her food allergy/drug allergy allergy/other allergy/eczema/chronic hives would go away

    • Not at all

    • Extremely

    Thank you for your help