Food Allergies/Sensitivities: Food Allergies and Health Disparities
By Sherry Coleman Collins, MS, RDN, LD
Vol. 24 No. 7 P. 16
An Overview of the Problem and What Dietitians Can Do to Help
Just as there’s a higher prevalence of chronic diseases, such as type 2 diabetes, CVD, and stroke, in Black and brown communities, coupled with a lack of access to health care for early diagnosis, treatment, and management, there also are health care disparities within these populations living with food allergies.
A randomized, cross-sectional survey of US households with children that estimated the prevalence and severity of childhood allergy found that food allergy prevalence was 8% and that risk of food allergy was significantly associated with age, income, geographic region, and race.1
Studies consistently have found that Black children and adults have higher rates of self-reported food allergies than their white peers.2 In fact, one study showed that the odds of having any food allergy were nearly twice that for Black children compared with white children, yet Black children were significantly less likely to have had a physician diagnosis, perhaps due to lack of access to specialty care.3
According to the Robert Wood Johnson Foundation, “Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health, such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.”4
Ruchi S. Gupta, MD, MPH, a professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine and director of the Center for Food Allergy & Asthma Research at Lurie Children’s Hospital of Chicago, says the two biggest challenges facing children with food allergies and their families are issues of access. First, she says that getting a diagnosis, management plan, and epinephrine are a challenge. “This is because getting to an allergist can be challenging, and primary care physicians usually do not make this diagnosis,” she says. In fact, there are less than 5,000 actively practicing allergists in the United States to serve a patient population of 32 million.”5,6 Seeing these specialists can be difficult for families who don’t live near an allergist or may experience other barriers to access. Secondly, Gupta says, is the ability to access safe foods. “Foods free from allergens are usually hard to find and cost more.”
Burdensome Cost of Food Allergies
The economic cost of childhood food allergy in the United States is estimated at $24.8 billion per year, which includes direct medical costs, special diets, and lost labor earnings, according to Gupta’s research.7 This is equivalent to more than $4,100 per allergic child. In many cases, one parent chooses to reduce their professional workload or leave the workforce entirely to manage the extra time needed to care for children with food allergies. These extra costs can be burdensome for families already experiencing food insecurity.
The cost of free-from foods (ie, those that don’t contain the most common allergens) can be significantly more than conventional staple foods, such as milk, bread, and peanut butter, making it more difficult for children to adhere to a diet calling for nonallergenic foods. Such a scenario may lead to poorer nutrition and more frequent visits to the emergency department due to accidental exposure.
According to Emily Brown, a parent of two children with food allergies, founder of the Free From Market, and former CEO of Food Equality Initiative, a food bank and advocacy organization she started to serve families with food allergies and those who are facing food insecurity, “The time and effort it takes to shop and read every label every time to avoid accidental exposure is significant. Add the additional burden of cost; food avoidance has been financially challenging for our family.” Brown expressed frustration with her experiences using the WIC program after the birth of her second child when she struggled to find safe foods the program covered. “Navigating food allergies in our social safety net is extremely challenging. Children with food allergies in the lowest income stratum spend 2.5 times more on emergency department and hospitalization costs, partially due to limited access to allergen-free foods.”8
In addition to the financial hardships associated with food allergies, a significant psychosocial burden exists. Families who deal with the challenges of racism and social injustice may feel more overwhelmed when food allergy management is added to their plate.
How RDs Can Help
Despite these challenges, dietitians can advocate for families who have children with food allergies. RDs can make appropriate referrals to allergists and help families locate them so their children can get diagnosed, obtain a food allergy management plan, and get prescriptions for emergency medications, if applicable. Receiving an accurate diagnosis helps families with limited food access from unnecessarily restricting affordable, nutritious foods. Once food allergies are confirmed, RDs can develop safe meal plans that fit their patients’ specific needs, while considering cost, accessibility, and cultural appropriateness. For example, RDs can recommend healthful foods naturally free from certain allergens that are affordable to prevent families from purchasing expensive prepackaged free-from foods.
RDs also can teach parents how to safely prepare nutritious meals that exclude common allergens, such as eggs and wheat. Home cooks must learn how to prevent cross-contact if they continue to use the allergen in their kitchens. RDs can educate families on how to read labels and navigate eating away from home, such as in schools and restaurants.
Moreover, dietitians can help families and children with food allergies overcome barriers to healthful eating, such as overrestriction and picky eating. “Many kids with food allergies eat only a few items they feel are safe all the time. They do not enjoy food but eat to survive. They fear foods they do not know. They fear new foods,” Gupta says. “Helping them learn how to identify safe foods and eat a full and safe diet is essential.” But just as it’s difficult to find certain specialists, access to dietitians also may be a challenge for those with limited funds and inadequate health insurance.
Pegah Jalali, MS, RD, CNSC, CDN, founder of Pediatric Dietitian, LLC, who specializes in pediatric food allergy in Martha’s Vineyard, Massachusetts, says, “Access to health care professionals who specialize in food allergy treatment like registered dietitians can be challenging for patients depending on their insurance coverage.”
To access nutritious foods, RDs can educate families about WIC, SNAP, the National School Lunch Program, and other nutrition assistance programs. Dietitians also can offer information on food pantries across the country that focus on free-from and gluten-free foods for individuals with food allergies.
“We have a food pantry in our pediatric clinic,” says Marion Groetch, director of nutrition services at the Jaffe Food Allergy Institute and an assistant professor in the division of allergy and immunology at Icahn School of Medicine at Mount Sinai, who also donates allergen-safe foods in her community since the local food pantry doesn’t have the ability to provide specialized foods.
Finally, dietitians can help families with infants implement food allergy prevention through early introduction of peanut and other food allergens.
Undoubtedly, families who have children with food allergies need the support of dietitians. Those who are food insecure need it even more. So, letting other health professionals know that this problem exists in the food allergy population is one step toward health equity for all.
— Sherry Coleman Collins, MS, RDN, LD, is president of Southern Fried Nutrition Services in Atlanta, specializing in food allergies, digestive disorders, and nutrition communications. Find her on Twitter, Instagram, and Facebook @DietitianSherry.
1. Gupta RS, Springston EE, Warrier MR, et al. The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics. 2011;128(1):e9-e17.
2. Warren CM, Turner PJ, Chinthrajah RS, Gupta RS. Advancing food allergy through epidemiology: understanding and addressing disparities in food allergy management and outcomes. J Allergy Clin Immunol Pract. 2021;9(1):110-118.
3. 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.
4. Braveman P, Arkin E, Orleans T, Proctor D, Plough A. What is health equity? Robert Wood Johnson Foundation website. https://www.rwjf.org/en/library/research/2017/05/what-is-health-equity-.html. Published May 1, 2017.
5. Active physicians with a U.S. doctor of medicine (U.S. MD) degree by specialty, 2019. Association of American Medical Colleges website. https://www.aamc.org/data-reports/workforce/interactive-data/active-physicians-us-doctor-medicine-us-md-degree-specialty-2019
6. FARE website. https://www.foodallergy.org/
7. 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.
8. Bilaver LA, Kester KM, Smith BM, Gupta RS. Socioeconomic disparities in the economic impact of childhood food allergy. Pediatrics. 2016;137(5):e20153678.