Patients on government assistance face difficulties in accessing allergen-free food
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LOUISVILLE, Ky. — Access to allergen-free food is difficult for families with food allergies who receive government assistance, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
Alissa A. Frame, BA, an MD/PhD student in the department of pharmacology at Boston University School of Medicine, called access a challenge for families who use the Women, Infants and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP).
“We hypothesized that consistent access to allergen-free options through those programs would be associated with better quality of life,” Frame told Healio.
The researchers recruited 53 caregivers of children aged 0 to 17 years with food allergies from an allergy clinic at Boston Medical Center, which is an urban safety net hospital. These families included 28 who did not use WIC, 12 who used WIC and reported consistent access to allergen-free food, and 13 who used WIC and reported inconsistent access.
“When we asked, they had sometimes, rarely or never had access,” Frame said.
These caregivers completed an online cross-sectional survey including socioeconomic and demographic information, a food allergy-related quality-of-life questionnaire and utilization of WIC, SNAP and food bank programs.
“The quality-of-life questionnaire looked at a number of sub-scores, like food allergy anxiety. Are you stressed all the time about being exposed?” Frame said. “Do you live in fear? Are you disappointed with how people are reacting to or accommodating your limitations?”
A little more than 20% of the children had one food allergy, whereas the others all had multiple food allergies, Frame said. The most common allergen was peanut, followed by tree nuts, egg, milk, sesame seed and soybean. Caregivers reported difficulties in accessing options through WIC and SNAP for each one of these allergens.
“When you break it down by allergy, and when you look at it all together as well, less than half of the people who responded were able to have consistent access to those food options through WIC or SNAP,” Frame said.
These difficulties were compounded when children had multiple food allergies, with those with more than one food allergy appearing significantly more likely to have inconsistent access to allergen-free food options through WIC (P < .01).
“We think that’s probably because a lot of the alternatives also contain a major specific allergen,” Frame said.
For example, the researchers pointed out, common dairy-free alternatives often include soy, which many of these children are allergic to as well.
Overall, the researchers found that multiple food allergies (P < .001) and inconsistent access to allergen-free foods through WIC and SNAP (P < .05) were significantly associated with worse quality of life related to food allergy.
“If you use WIC and have consistent access, the quality-of-life score was actually identical to that of people who did not use WIC at all,” Frame said. “But when you have inconsistent access to the food options that you need, then quality of life drops.”
When the researchers asked the caregivers which allergy-safe foods they wished WIC provided, four said they wanted dairy alternatives, and two said they would want Ripple milk, a vegan, allergen-free milk. Nut-free butter, cereal and snack alternatives, fruits and special formula also were mentioned by one caregiver each. Yet these options may be difficult to find.
“A lot of the families who use WIC and SNAP live in food deserts,” Frame said. “The places that they can go aren’t necessarily going to have soy-free, dairy-free milk alternatives.”
Travel to stores that provide these options is challenging too, considering the need to find transportation to get to these places and take time to make the journey.
“You don’t have the money to get there and buy those options,” Frame said.
Also, Frame said that WIC and SNAP do not provide additional money to families with food allergies.
“If you have a certain amount of money to use toward milk but you need Ripple milk, then you can’t get what you need,” Frame said. “So, you’re working with a functionally lower budget.”
Doctors should keep these difficulties in mind as they meet with these families, Frame said.
“It’s really easy to say, ‘OK, here, fill out this form for WIC, fill out this form for SNAP, and go on your way and get what you need,’” Frame said. “Understand that these families probably need a bit more support in being able to find those foods.”
Frame also hopes that these data will be useful in driving policy changes that would help these families get the help they need.
“It’s tough because most of these programs operate by providing money for food. But you have families who are living in places where those foods aren’t even available,” she said. “But if a family has a documented food allergy or even, honestly, a self-reported one, giving them more money to buy those foods would be an easy place to start.”
In the meanwhile, more research is necessary, Frame said.
“We need to look more closely at the link between the number of food allergies and access and quality of life, because obviously those things can feed into each other, to see what’s really driving the train there,” she said. “It’s a complicated picture, but it’s actionable, and it is a way that we can help improve quality of life for these families.”