Disparities, food insecurity impact families with food allergy in vulnerable communities
Key takeaways:
- 42% of respondents in Eastern Virginia had an epinephrine prescription, and 43% had written action plans.
- 73% said they were food insecure, and 51% had used a food bank in the previous year.
SAN DIEGO — Patients with food allergy in vulnerable communities experience significant disparities in diagnosis and management, including food insecurity, according to a pair of posters presented here.
Improved access to care and resources would benefit these communities, Anita Roach, MS, vice president of health equity and community, Food Allergy Research & Education (FARE), said at the 2025 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress.
“The survey was part of the FARE Neighborhoods Initiative community health needs assessment, aimed at addressing food allergy inequities in under-resourced regions, including those affected by redlining,” Roach told Healio.
The survey aimed to explore the intersection of food allergy prevalence, access to health care, food insecurity and the legacy of redlining across these neighborhoods, with a particular focus on Eastern Virginia, she continued.
“The goal was to understand the specific challenges faced by households managing food allergy in these communities and to inform targeted interventions,” Roach said.
The online survey polled 1,154 households with at least one diagnosed food allergy between November 2023 and January 2024 in five regions the researchers called underserved: Newark, New Jersey; Chicago; Dekalb County, Georgia; Central Arkansas; and Eastern Virginia.
“The survey data from Eastern Virginia show significant disparities in food allergy diagnosis, management and access to health care, particularly in communities that have been historically redlined,” Roach said.
The Eastern Virginia cohort included 209 respondents (median age, 43 years; 53% Black), with 25% of those with food allergy aged younger than 18 years.
“Many lived in areas with high social vulnerability. These areas, which overlap with historically redlined districts, experience not only limited access to allergy care but also heightened food insecurity,” Roach said.
Roach defined food insecurity as a lack of consistent access to enough food, or food that meets an individual’s needs, for an active and healthy life.
“It can involve situations where households worry whether their food will run out before they have money to buy more, or where the food bought does not last and there is not enough money to get more,” she said. “This can lead to reduced food intake, hunger and a disruption of normal eating patterns.”
Food insecurity rates include 10% of the general U.S. population and 57% of the families with food allergy in this survey, Roach said, even though 82% of participants were above the poverty line. Also, 27% of respondents specifically had trouble accessing allergy-safe foods, which Roach called critical in communities already experiencing economic and health care inequities.
“This is significantly higher than in communities without food allergy, where the availability of allergen-free food is often less of a concern,” she said.
Allergens included shellfish (38%), peanuts (29%), tree nuts (25%) and milk (34%). Nearly all these cases of food allergy (94%) were diagnosed, including 59% of diagnoses by non-allergists.
Also, 42% of these patients had an epinephrine prescription, and 86% of them adhered to their prescriptions. Health care providers educated 45% of these patients about epinephrine, and 43% of these patients had written action plans.
Most of the cohort (72%) had Medicaid or Medicare. Additionally, 45% lived in areas with medium to high Social Vulnerability Index scores that also correlated with districts that were historically redlined.
Across all five surveyed regions (n = 925), 73% said that they were food insecure, including 51% who said they had used a food bank within the previous year and 21% who could consistently find allergy-safe foods there.
Proportions of respondents reporting food insecurity included 67% of those who felt that they had a moderate to high risk for fatality due to food allergy and 55% of those who felt that their risks were lower (P < .001). Specifically, the Eastern Virginia cohort included 71% who were concerned about fatal reactions.
Respondents who said that they were experiencing psychologic distress such as anxiety and depression were more likely to report food insecurity than those who were not (90% vs. 56%; P < .001) as well.
Roach called the added psychosocial burden including loneliness and fear of eating, with a notably higher perceived risk for fatal reactions, among people with food allergy in food-insecure households and in marginalized neighborhoods profound.
“These mental health outcomes are critical for understanding the broader impact of food allergy in socioeconomically disadvantaged communities,” she said.
Based on these findings, the researchers said that there are significant disparities in food allergy diagnosis and management among patients in vulnerable communities, with food insecurity a particularly prevalent concern.
The researchers called for improved access to food allergy care, community resources and allergy-safe foods in addition to interventions that would increase public support for these patients.
“Physicians can play a key role by actively screening for food insecurity in their food-allergic patients, particularly those from low-income or historically marginalized communities,” Roach said.
Routine screenings for food insecurity and referrals to social services can help address the nutritional and emotional needs of these patients as well, she continued.
“Additionally, increasing awareness of the unique challenges faced by food-allergic patients in food deserts, rural areas and communities with limited access to allergy-safe foods is crucial for improving patient outcomes,” Roach said.
At the policy level, Roach also noted a need for broader accessibility to foods that can support FARE’s Eat Early, Eat Often program for introducing allergens into infant diets and allergen-safe foods for those who need it through food assistance programs such as the Special Supplemental Nutrition Program for Women, Infants, and Children.
“Moreover, there should be enhanced funding for community-based initiatives like the FARE Neighborhoods Initiative, which aim to address the root causes of disparities in food allergy awareness and management,” Roach said.