Why having a food allergy costs more for the poorest kids

What is the financial toll of having a kid with a food allergy? The answer may depend on how much money you have.

A new study published this week in Pediatrics found that food-allergic children from households that earn less than $50,000 a year incur 2.5 times the cost of emergency room visits and hospital stays compared with their peers from families that are in a higher-income bracket.

At the same time, families that make more than $100,000 a year report spending more of their own money on visits to allergy specialists for their kids, as well as medicines paid for out of pocket, compared with families from lower-income groups.

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Dr. Ruchi Gupta, an associate professor of pediatrics at Northwestern University who led the study, said the findings suggest that caregivers from households with the lowest incomes may not be able to afford preventative treatment for their food-allergic children. This type of treatment -- which is often paid for out of pocket -- includes buying special allergen-free foods, seeing an allergy specialist who can do a full panel of allergy tests, and having an epinephrine auto-injector, such as an EpiPen, on hand.

Without access to these tools, she said, poor kids are more likely to wind up in the emergency room with a severe allergic reaction.

“There are currently no treatments for food allergies, so all we have is prevention,” she said. “And the only way to prevent an allergic reaction is to not come in contact with the food.”

The new analysis is based on a cross-sectional study of 1,643 caregivers of food-allergic children. Respondents were split into three income groups -- those with an annual household income of less than $50,000, those who made $50,000 to $100,000 a year, and those who made more than $100,000.

The authors report that the lowest-income families incurred costs of $1,021 a year for emergency room and hospital stays, compared with $416 a year for the highest-income group.

The lowest-income group spent slightly more on pediatrician costs than higher-income groups ($123 versus $103) but less on specialist visits ($228 versus $311).

All told, Gupta said, the cost to the U.S. population for prevention and treatment of allergic reactions is estimated to be $24.8 billion a year.

One finding that Gupta found surprising is that families of African American children with food allergies report fewer visits to the emergency room than other groups, as well as the least spending on out-of-pocket costs.

“We’re not sure what to make of that,” she said. “But it definitely makes me want to do a deeper dive to understand food allergies in different populations.”

Food allergies affect 8% of children in the United States and almost 40% of those children have experienced a life-threatening reaction, the authors said.

“Food allergies can impact any of your organ systems,” Gupta said. “We see hives, throat closing or feeling itchy, swelling around the mouth or other parts of the body, trouble breathing, fainting and dizziness. And it can be caused by just a little bit of the food that you are allergic to.”

Some of the most common foods that kids are allergic to include eggs, dairy products, peanuts, tree nuts like pistachios and walnuts, shellfish, wheat and soy.

At the end of the paper, the authors advocate for improving access to care and preventative measures for lower-income kids.

“These poorer kids are not getting the same preventative treatment as other children,” she said. “Our next step is to do more qualitative work to see how we change that in so many ways.”

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