Children with food allergy experience greater odds for food insecurity

Key takeaways:

• 4.7% of children with a physician-diagnosed food allergy screened positive for food insecurity.
• The American Academy of Pediatrics recommends universal screenings for food insecurity.

Children with food allergy had greater risks for food insecurity, underscoring the need to assess for food insecurity in allergy practices, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

When screenings indicate food insecurity, families should be referred to appropriate support services, Hao Tseng, MD, MSc, resident in the department of pediatrics, and Maria-Anna Vastardi, MD, assistant professor of pediatrics and medicine, both at SUNY Downstate Health Sciences University, wrote.

Defining food insecurity as a lack of consistent access to sufficient food for an active and healthy life, the researchers noted strong associations between food insecurity and poor health and developmental outcomes.

With estimated costs of $4,184 per child with food allergy per year, the researchers continued, households with food allergy are at higher risk for food insecurity, driven partly by the costs of special diets and allergen-free foods.

Although the American Academy of Pediatrics (AAP) recommends that pediatric practices conduct universal screenings for food insecurity, the researchers continued, the American Academy of Allergy, Asthma & Immunology has found a lack of these screenings in allergy practices.

This retrospective review investigated the electronic health records of all patients aged 6 months and older seen in the primary care pediatric clinic of NYC Health + Hospitals/Kings County between October 2020 and June 2022.

The pediatricians at this clinic use a two-item tool recommended by the AAP and embedded in the EHR to screen for food insecurity. This screening is required as part of every physician-patient encounter.

The first item asks caregivers if they worried whether their food would run out before they got money to buy more. The second item asks if the food they bought did not last and if they did not have money to get more.

When patients answer yes to one or both questions, the physician documents it in the EHR, using the International Classification of Diseases, 10th Revision diagnosis code for food insecurity.

The study involved 7,856 children (mean age, 8.7 years; 48.9% girls; 84.9% Black). This cohort included 74.1% enrolled in Medicaid, 89.3% living in low-income neighborhoods and 0.2% living in neighborhoods with low access to food stores.

Among the 275 children with a physician-diagnosed food allergy, 4.7% were positive for food insecurity. In contrast, 2.6% of the 7,581 children who did not have a physician-diagnosed food allergy were positive for food insecurity (P = .029).

After adjusting for age, gender, race, ethnicity, health insurance and ZIP code, the researchers found that children with a physician-diagnosed food allergy were 2.21 (95% CI, 1.22-3.98) times more likely to have food insecurity than those who did not have a physician-diagnosed food allergy.

The researchers also found that children with self-reported food allergy and self-reported multiple food allergies may have higher rates of food insecurity as well, with similar correlations for peanut, shellfish, egg, fish, tree nut, milk and soy allergy, but these results were not statistically significant.

Physicians at NYC Health + Hospitals refer patients with food insecurity to social workers and food navigators who help them access programs such as the Supplemental Nutrition Assistance Program, the Special Supplemental Nutrition Program for Women, Infants and Children and the National School Lunch Program. A social service directory integrated into the EHRs streamlines these referrals.

Considering these increased odds for food insecurity among children with food allergy, the researchers called for additional research exploring why they are more likely to experience food insecurity and why allergy practices conduct limited screenings when they should be routine.