Disparities exist in care for low-income kids with food allergy

Low-income families of children with food allergies spend 2.5 times more on emergency department and hospitalization costs nationally, according to new Northwestern Medicine research.

The dependence on emergency care means children with food allergies from low-income families may not be able to afford foods free of their food allergen, obtain epinephrine or see an allergist who would counsel them on prevention and management of their food allergies.

"This shows disparities exist in care for low-income children with food allergy," said lead investigator Dr. Ruchi Gupta. "The first line management for food allergy is prevention, but costs for special foods and epinephrine auto injectors can be a barrier for many families. Some patients may not have access to allergen-free foods and cannot afford to fill their prescription."

Gupta is an associate professor of pediatrics at Northwestern University Feinberg School of Medicine and an attending physician at Ann & Robert H. Lurie Children's Hospital of Chicago.

Low-income families may be unfamiliar with programs that can help them receive epinephrine at low costs.

The paper was published in Pediatrics April 27.

"We are worried these children are not getting access to specialty care to provide detailed education and confirmation of their allergies," Gupta said. "This leads to more potential life-threatening allergic reactions that lead to more emergency room visits."

Lower-income families also tend to incur fewer costs for specialty care and spend less on out-of-pocket medication costs.

Researchers analyzed data from a national survey of 1,643 caregivers of food-allergic children and found that children from low socioeconomic backgrounds had lower odds of being diagnosed by a physician.

"The specialists are the ones who provide a lot of education and guidance for families with food allergy, and these families are missing out on that," said first author Lucy Bilaver.

Bilaver was a postdoctoral fellow at the Center for Healthcare Studies at Feinberg when she worked on the study and now is an assistant professor of nursing and health studies at Northern Illinois University.

The lowest income families were paying $1,021 per year for emergency and hospitalization costs compared to $416 per year for the highest income group.

Researchers also point out families with lower socioeconomic status often lack the financial means and access to allergen-free foods to prevent allergic reactions before they start. They suggest pediatricians work with families to create an action plan detailing how to recognize allergic reactions, including when and how to give epinephrine. Additionally, more needs to be done to ensure families can access safe foods.