Food allergies have become synonymous with the upper-middle class; there’s probably a punchline somewhere about all the nut-free, gluten-free, dairy-free items in a Whole Foods shopping cart at this very moment. But, the reality is, food allergies plague every socioeconomic group in the nation; 8% of children in the United States have at least one food allergy. Wealthier families just have the means to proactively manage them.
The cost of living allergen-free is steep; collectively, the US spends $25 billion a year, or $4,000 per child, to manage food allergies. It’s estimated that $4.3 billion of that is spent on direct medical bills, medication, and specialists, and the rest is spent on various preventive measures families must take to keep their kids safe, like purchasing allergen-free foods, and investing in epinephrine shots that combat allergic reaction-induced anaphylaxis.
For affluent families, managing food allergies is an inconvenient, but manageable, necessity. However, for families already struggling to afford basic needs, springing for the extra expenses that managing allergies requires is not an option.
The only way to prevent an allergic reaction is to not come into contact with the food allergen, so most prevention measures take place at the grocery store. But allergen-free foods aren’t inexpensive; one study found that gluten-free products were 242% more expensive than comparable items. Besides the lack of affordability of allergen-free food, it is also often inaccessible. Food insecurity is a major Social Determinant of Health that lower-income communities already face; locating gluten-free options, for example, is even more difficult.
Despite best efforts to avoid food allergens, allergic reactions are common; 40% of children have experienced a life-threatening allergic reaction as a result of coming into contact with a food allergen. For most, that means anaphylaxis – which can cause hives, swelling, coughing, and difficulty breathing or loss of consciousness.
Epinephrine is a saving grace for those experiencing anaphylaxis – but not every family has one on hand. Standard auto-injector epinephrine shots cost around $200 just for a two-pack. While there are discounts to reduce out-of-pocket expenses, the price tag is enough of a deterrent that low-income families will keep old, expired Epi-pens on hand, or none at all.
The only other option to treat anaphylaxis without epinephrine is a trip to the hospital. This is where low-income families will spend their money on allergies – in the ER. Families with food allergies earning less than $50,000 a year sustain 2.5 times the cost of emergency room visits compared with families of higher income brackets.
The lack of access to effective preventive measures and life-saving epinephrine puts children at much higher risk of not only experiencing anaphylaxis, but dying from it. Controlling this Emergency Department utilization in a low-income population is a major challenge for both payers and providers.
Increasing access to improve outcomes
The Food Equality Initiative recognizes that managing food allergies is expensive and challenging, and low-income families disproportionately suffer because of it. They collaborate with healthcare, wellness and government experts in an effort to narrow that gap. By providing allergen-friendly food, nutrition education and advocacy for the food insecure, FEI strives toward their mission to increase health and end hunger.
Food allergies affect everyone, not just those who have the means to speak up about it. Organizations like the Food Equality Initiative act as the much-needed safety-net, and also the voice, for those that can’t acquire the resources on their own. Connecting struggling families to resources like FEI will not only mitigate the cost of managing food allergies, but improve health outcomes for those in need.