Allergy & Immunology

Food Allergies

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Economic Considerations With Food Allergies: The Impact of Food Insecurity

patient care perspectives by Ruchi Gupta, MD, MPH
Overview

For patients with food allergies and their families, food insecurity can have a significant impact on how they manage their condition. Ruchi Gupta, MD, MPH, discusses economic considerations in diagnosing and managing food allergies and the impact of food insecurity.

Expert Commentary
“Food insecurity is even harder for low-income families who have food allergies because they are limited in what they can get from food pantries and other sources that they are sure is safe to eat.”
— Ruchi Gupta, MD, MPH

Food insecurity has been around for a long time, but we saw increased food insecurity during the COVID-19 pandemic, and this shined some light on the issue. In the United States, food insecurity impacts approximately 35 million individuals, and food allergies affect approximately 32 million individuals. So, a lot of people are impacted by one or the other, and there is a group affected by both.

 

Childhood food allergies cost approximately $24 billion annually in the United States. What is really interesting is that, when you look by income level, low-income families with food allergies spend approximately double the amount of money on Emergency Department visits but spend less on special diets, medications, and specialist visits. It is important to understand that these families may not get their epinephrine autoinjector or special foods. Food insecurity is even harder for low-income families who have food allergies because they are limited in what they can get from food pantries and other sources that they are sure is safe to eat. This has become a big area that we tried to highlight during and after the COVID-19 pandemic.

 

How do we currently screen for food insecurity in patients with food allergies? A working group of the American Academy of Allergy, Asthma & Immunology (AAAAI) sent out a survey to a random sample of AAAAI members and found that most members do not routinely screen for food insecurity. There are a couple of issues with this. First, these members did not realize how big of an issue food insecurity is in patients with food allergies, and second, even when they want to screen, they do not know how to do it and they also do not know what to do if the screen is positive. So, I think that those are areas that we really need to work on. There is a 2-question, validated food insecurity screening tool that we have asked allergists to incorporate into their note template that might help address this.

 

If allergists incorporate screening, or even if they ask about food insecurity, the next big piece is: What do they do? What resources do they have that they can use to support their patients? At the national level, we are trying to create a national database so that individual allergists or pediatricians can guide families and connect them to the right resources. Some local organizations, such as the Food Equality Initiative, have started an online way of delivering safe food, and food pantries have become more aware of food allergies. But often, what comes into the food pantries is not up to them.

References

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Gupta R, Holdford D, Bilaver L, Dyer A, Holl JL, Meltzer D. The economic impact of childhood food allergy in the United States. JAMA Pediatr. 2013;167(11):1026-1031. Published correction appears in JAMA Pediatr. 2013;167(11):1083.

 

Gupta RS, Warren CM, Smith BM, et al. Prevalence and severity of food allergies among US adults. JAMA Netw Open. 2019;2(1):e185630. doi:10.1001/jamanetworkopen.2018.5630

 

Gupta RS, Warren CM, Smith BM, et al. The public health impact of parent-reported childhood food allergies in the United States. Pediatrics. 2018;142(6):e20181235. Published correction appears in Pediatrics. 2019;143(3):e20183835.

 

Hager ER, Quigg AM, Black MM, et al. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010;126(1):e26-e32. doi:10.1542/peds.2009-3146

 

Jefferson AA, Davidson L, Scurlock AM, Stern J. Food insecurity and health inequities in food allergy. Curr Allergy Asthma Rep. 2024;24(4):155-160. doi:10.1007/s11882-024-01134-0

 

Scurlock AM, Brown E, Davis CM. Food insecurity in children and adults with food allergies. Ann Allergy Asthma Immunol. 2022;129(4):424-429. doi:10.1016/j.anai.2022.08.012

 

Shroba J, Das R, Bilaver L, et al. Food insecurity in the food allergic population: a work group report of the AAAAI Adverse Reactions to Foods Committee. J Allergy Clin Immunol Pract. 2022;10(1):81-90. doi:10.1016/j.jaip.2021.10.058

Ruchi Gupta, MD, MPH

    Professor of Pediatrics and Medicine
    Director, Center for Food Allergy & Asthma Research
    Northwestern University Feinberg School of Medicine
    Clinical Attending, Ann & Robert H. Lurie Children’s Hospital of Chicago
    Chicago, IL


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