Abstract
Purpose of Review
The intersection of food insecurity among those with food allergy is a growing public health concern. Both food allergy and food insecurity have profound implications on health, social, and economic outcomes. The interaction of social determinants of health, poverty, racism, housing insecurity, and access to care has direct impact on individuals with food allergy.
Recent Findings
There is increasing evidence that universal screening for food insecurity is vital in the routine care of patients with food allergy. Individuals with food allergy who are also burdened by food insecurity face unique challenges related to the need to maintain dietary modifications often with expensive specialized diets, which are difficult to access. This may lead to limited dietary options, malnutrition, increased financial burden, and social isolation. While there are available resources and support systems that can assist individuals with food allergies in managing food insecurity, there is an increasing need for advocacy and inclusivity in policy frameworks involving multiple stakeholders.
Summary
Multi-sector efforts involving healthcare providers and advocacy and government agencies are necessary to support policy changes that protect the rights and well-being of individuals affected by food allergy and food insecurity. By increasing awareness, improving access to safe, affordable, allergen-free food, and advocating for policy change, we can work toward ensuring universal access to safe, nutritious food for all individuals, regardless of their food allergy status or socioeconomic background.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Gupta RS, Warren CM, Smith BM, et al. Prevalence and severity of food allergies among US adults. JAMA Network Open. 2019;2(1).
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.
Bilaver LA, Chadha AS, Doshi P, O’Dwyer L, Gupta RS. Economic burden of food allergy: a systematic review. Ann Allergy Asthma Immunol. 2019;122(4):373-380.e371.
Warren CM, Jiang J, Gupta RS. Epidemiology and Burden of food allergy. Curr aller Asthma Rep. 2020;20(2).
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.
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):e9-17.
Jiang J, Warren CM, Brewer A, Soffer G, Gupta RS. Racial, ethnic, and socioeconomic differences in food allergies in the US. JAMA Netw Open. 2023;6(6): e2318162.
Muraro A, de Silva D, Halken S, et al. Managing food allergy: GA(2)LEN guideline 2022. World Allergy Organ J. 2022;15(9): 100687.
Durban R, Groetch M, Meyer R, et al. Dietary management of food allergy. Immunol Allergy Clin North Am. 2021;41(2):233–70.
Shaker MS, Schwartz J, Ferguson M. An update on the impact of food allergy on anxiety and quality of life. Curr Opin Pediatr. 2017;29(4):497–502.
Warren C, Dyer A, Lombard L, Dunn-Galvin A, Gupta R. The psychosocial burden of food allergy among adults: a US population-based study. J Allergy Clin Immunol Pract. 2021;9(6):2452-2460.e2453.
Pepper AN, Assa’ad A, Blaiss M, et al. Consensus report from the Food Allergy Research & Education (FARE) 2019 Oral Immunotherapy for Food Allergy Summit. J Allergy Clin Immunol. 2020;146(2):244–9.
Boyce JA, Assa’ad A, Burks AW, et al. NIAID-sponsored expert panel: guidelines for the diagnosis and management of food allergy in the United States: report of the NIAID-sponsored expert panel. J Aller Clin Immunol. 2010;126.
Sindher SB, Long A, Chin AR, et al. Food allergy, mechanisms, diagnosis and treatment: Innovation through a multi-targeted approach. Allergy. 2022;77(10):2937–48.
Sampath V, Abrams EM, Adlou B, et al. Food allergy across the globe. J Allergy Clin Immunol. 2021;148(6):1347–64.
Togias A, Cooper SF, Acebal ML, et al. Addendum guidelines for the prevention of peanut allergy in the United States: report of the National Institute of Allergy and Infectious Diseases-sponsored expert panel. J Allergy Clin Immunol. 2017;139(1):29–44.
Coleman-Jensen A, Rabbitt MP, Gergory CA, Singh A. Household food security in the United States in 2021, ERR-309. Economic Research Service: U.S. Department of Agriculture; 2022.
USDA. Food Security in the US. 2023.
• Scurlock AM, Brown E, Davis CM. Food insecurity in children and adults with food allergies. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2022;129(4):424–429. In this review, the authors provide recommendations for screening, intervention, and advocacy efforts, including an extensive list of food and nutrition program resources for patients with food insecurity.
•• American Academy of Pediatrics and Food Research and Action Center: Screen and intervene: a toolkit for pediatricians to address food insecurity. 2021. In this comprehensive toolkit, the authors provide a framework for universal screening and intervening to address food insecurity using a culturally relevant, patient centered approach.
Thomas MMC, Miller DP, Morrissey TW. Food insecurity and child health. Pediatrics. 2019;144(4).
Brown E, Das R, Brewer AG, Martinez E, Bilaver LA, Gupta RS. Food insecure and allergic in a pandemic: a vulnerable population. J Allergy Clin Immunol Pract. 2020;8(7):2149–51.
Bilaver LA, Das R, Martinez E, Brown E, Gupta RS, Love M. Addressing the social needs of individuals with food allergy and celiac disease during COVID-19: a new practice model for sustained social care. Soc Work Health Care. 2021;60(2):187–96.
World Health Organization. Social determinants of health.
Dehborzogi S, Ramsey N, Sang Eun Lee A, Coleman A, Varshney P, Davis C. Addressing health equity in food allergy. J Aller Clin Immunol Pract. 2024.
Davis CM, Apter AJ, Casillas A, et al. Health disparities in allergic and immunologic conditions in racial and ethnic underserved populations: a work group report of the AAAAI committee on the underserved. J Allergy Clin Immunol. 2021;147(5):1579–93.
Benson C. Poverty rate of children higher than national rate, lower for older populations. U.S. Census Bureau America Counts: Stories Web site. 2023. https://www.census.gov/library/stories/2022/10/poverty-rate-varies-by-age-groups.html. Published 2022. Accessed Sept 1, 2023.
Bartnikas LM, Dupuis R, Wang J, Phipatanakul W. Food allergies in inner-city schools: addressing disparities and improving management. Ann Allergy Asthma Immunol. 2022;129(4):430–9.
Polk BI, Dinakar C. Patient-centered outcomes in food allergy. Curr Allergy Asthma Rep. 2017;17(6):39.
•• Coleman AT, Sharma H, Robinson A, et al. Access to allergen-free food among Black and White children with food allergy in the FORWARD study. J Allergy Clin Immunol Pract. 2022;10(1):182–188. This study provides important insights into access to safe, allergen free foods in food-allergic children, observing that Black children have less access to allergen free foods than White children, with much of the difference accounted for by socioeconomic status.
Taylor-Black SA, Mehta H, Weiderpass E, Boffetta P, Sicherer SH, Wang J. Prevalence of food allergy in New York City school children. Ann Allergy Asthma Immunol. 2014;112(6):554-556.e551.
Mahdavinia M, Fox SR, Smith BM, et al. Racial differences in food allergy phenotype and health care utilization among US children. J Allergy Clin Immunol Pract. 2017;5(2):352-357.e351.
•• Mahdavinia M, Tobin MC, Fierstein JL, et al. African American children are more likely to be allergic to shellfish and finfish: findings from FORWARD, a multisite cohort study. J Aller Clin Immunol Pract. 2021;9(7):2867–2873.e2861. In this multicenter cohort study, investigators observed that food-allergic, African-American children had higher odds of allergy to fish and shellfish, higher rates of asthma, and a potentially higher risk of severe or potentially fatal reactions.
Dupuis R, Phipatanakul W, Bartnikas LM. Social disparities in early childhood prevention and management of food allergy. J Allergy Clin Immunol. 2023;151(1):37–41.
Bozen A, Zaslavsky JM, Cohn D, et al. Barriers to food allergy management among Americans with low income. Ann Allergy Asthma Immunol. 2020;125(3):341–3.
Brewer AG, Jiang J, Warren CM, et al. Racial differences in timing of food allergen introduction. J Allergy Clin Immunol Pract. 2022;10(1):329-332.e322.
Arteaga I, Wilde PE. Measuring food security in the United States for more than 25 years: history, methods, findings, and opportunities. J Acad Nutr Diet. 2023;123(10s):S5-s19.
ERS U. Food security in the US. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/measurement/.
Bickel G NM, Price C, Hamilton W, Cook J. Measuring food security in the united states: guide to measuring household food security. 2000.
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):e26-32.
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.
Barnidge E, LaBarge G, Krupsky K, Arthur J. Screening for food insecurity in pediatric clinical settings: opportunities and barriers. J Community Health. 2017;42(1):51–7.
Tepler E, Wong KH, Soffer GK. Health disparities in pediatric food allergy. Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology. 2022;129(4):417–23. https://foodequalityinitiative.org. Accessed Sept 1, 2023.
• Jones SM, Anvari S, Coleman A, et al. Food insecurity and allergic diseases: a call to collective action. J Aller Clin Immunol. 2023. In this review, the authors issue a collective call to action for the allergy/immunology specialty to address food insecurity through screening, intervention, and advocacy efforts.
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Jefferson, A.A., Davidson, L., Scurlock, A.M. et al. Food Insecurity and Health Inequities in Food Allergy. Curr Allergy Asthma Rep 24, 155–160 (2024). https://doi.org/10.1007/s11882-024-01134-0
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DOI: https://doi.org/10.1007/s11882-024-01134-0