Food allergies more likely to be outgrown when children have private insurance

Key takeaways:

• 21% of the full cohort outgrew at least one allergy.
• Patients outgrew these allergies by a mean age of 5.31 years.
• The most common outgrown allergies were milk and egg.

ANAHEIM, Calif. — Children with private insurance were more likely to outgrow food allergies than those with public insurance, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

“Despite the rising prevalence of food allergies, some children outgrow their food allergies. However, there are limited data on the development of clinical tolerance in food allergy,” Arabelle Abellard, MD, MSc, PGY5 allergy and immunology physician fellow at Rush University Medical Center, told Healio.

“For this reason, we wanted to investigate factors that may be associated with outgrowing food allergies in children,” she said.

Study results

The researchers evaluated 188 children (62% boys; 51% Black) aged 12 years and younger with an IgE-mediated, physician-diagnosed food allergy in Food Allergy Management and Outcomes Related to Racial/Ethnic Differences (FORWARD), which Abellard called one of the largest prospective studies of children with food allergies.

The cohort included 39 (21%) children who outgrew at least one food allergy, including 72 total food allergies outgrown. These patients outgrew these allergies by a mean age of 5.31 years (standard deviation [SD], 3.5). The most frequently outgrown allergies included milk, then egg, tree nuts, soy and peanut.

The patients who outgrew these allergies included nine (12%) who had public insurance and 26 (29%) who had private insurance. Also, the one patient who did not have any insurance did not report an outgrown allergy.

Four of the 16 patients who did not have any insurance information available or entered in the data extraction tool outgrew an allergy as well. Whether these patients had insurance was unclear, Abellard said.

“Additional investigation is needed to further characterize those patients and refine the analysis,” Abellard said.

Also, the patients who developed a tolerance developed their food allergy at a mean age of 3.19 years (SD, 2.7), whereas the patients who did not develop tolerance developed their allergy at a mean age of 4.3 years (SD, 3.61), which the researchers called a significant difference (P = .043).

Conclusions, next steps

Despite these results, Abellard said, we do not clearly understand why some children outgrow their food allergies and others do not.

“More research is needed to help identify intrinsic and extrinsic factors that may be associated with the development of tolerance,” she said.

Abellard said that she and her colleagues are now analyzing a larger cohort of children from FORWARD, including four large urban tertiary care centers.

“This study focused on one study site at Rush University Medical Center and was a pilot, preliminary analysis,” Abellard said. “We are now conducting more studies to further confirm these findings and identify other predictors of tolerance.”

However, Abellard also said that the significant association between type of insurance and outgrown food allergies likely points to social determinants of health that influence outcomes.

“Suboptimal follow-up and monitoring may, at least in part, help explain the differences observed,” Abellard said.

Children with Medicaid or public insurance, particularly those from disadvantaged racial and ethnic groups, may face barriers to care because of underinsurance and gaps in coverage that decrease health care access, she explained.

“Their caregivers may make decisions with the expectation of losing coverage and may prefer fewer follow-ups,” Abellard said.

Additionally, she said, insurance plans do not cover all health-related financial expenses such as transportation costs, lost work time for caregivers and lifestyle modifications.

“There may be fewer resources within the family, including lower income, limited education, language proficiency, and health literacy,” Abellard said.

More analyses are needed to confirm these findings, Abellard said, but the results are interesting as well as encouraging as some children with food allergies can develop clinical tolerance.

It also is necessary to consider how social determinants of health can influence health outcomes, she continued. “Patient/caregiver education is critical, and physician awareness of social determinants of health matters,” Abellard said.

“Keeping in mind health disparities, further identification of children who have developed clinical tolerance may potentially be achieved through a targeted approach and proactive measures that engage children with food allergies and their caregivers and monitor them regularly,” she said. “We need more longitudinal data.”

Reference:

• Study shows children with private insurance more likely to outgrow food allergies. hhttps://acaai.org/news/study-shows-children-with-private-insurance-more-likely-to-outgrow-food-allergies/. Published Nov. 9, 2023. Accessed Nov. 10, 2023.