The Gap in Food Allergy Research: The Psychosocial Impact of Food Allergies on Lower-Income Families
I first became exposed to food allergy research in college when I began using my school's library database. I was studying psychology at the time and found myself fascinated by the few articles that shed light on the relationship between food allergies and mental health. Reading scientific research that documented the links between food allergies and mental health conditions like anxiety made me feel less alone. It was so validating to see that my own struggles with my mental health and food allergies were not just a part of my unique experience, but were a real thing that others experienced as well. Once I started graduate school, I continued this research as my fascination with the intersection of food allergies and mental health developed from an interest into my purpose. Learning from and working with families from marginalized communities in my clinical work has opened my eyes to how much of the research done on the impact of food allergies is focused on white upper middle-class families and has allowed me to see how inaccessible healthcare is for individuals from a lower socioeconomic status and/or racial minority group.
The research question that continues to echo in my head as I continue with my career in social work is: what are the psychosocial needs of lower-income families with food allergies? Given the current context of the COVID-19 pandemic, this question has become even more salient as I think there is a lot of valuable research that can be done to gain an understanding of the needs and experiences of these families during the pandemic so that clinicians, organizations, and even the government can better support them. While there is little research that answers this question as of December 2021, I wanted to provide a brief overview of some of the existing literature on the impact of food allergies on families and highlight some research that has been done on lower-income communities.
The Costs of Food Allergies on Higher-Income Families
Research on food allergies has been burgeoning over the last decade largely in part due to the rate of food allergies among children increasing in the United States (Quach & John, 2018). Food allergies affect approximately five million children in the United States (McGowan et al., 2015). Many researchers have documented the immense financial costs that food allergies incur not only to society, but to individuals and families as well. In the United States, food allergies are estimated to cost families a total of $24.8 billion per year (Gupta et al., 2013). In addition to the financial costs of food allergies requiring expensive medical treatment, families with food allergies also experience many indirect and intangible costs like losing out on career opportunities and dealing with more stress than families without food allergies (Frykas et al., 2021; Minaker et al., 2014). For higher-income families, food allergies significantly impact caregivers’ career choices (Frykas et al., 2021). One study found that mothers of children with food allergies from a higher socioeconomic background removed themselves from the workforce or reduced their hours to accommodate their child’s needs (Frykas et al., 2021). Gupta et al., found that food allergies cost $4184 per child in the United States (2013). The extreme costs of food allergies on higher-income families underscores the disproportionate burden that lower-income families face in caring for children with food allergies, as they do not have the option to leave the workforce or reduce their hours (Frykas et al., 2021; Bozen et al., 2020).
The Intersectionality of Race and Socioeconomic Status with Food Allergies
Various studies have found racial and socioeconomic disparities in food allergies (Davies et al., 2021; Shah et al., 2014). While Black and Asian children have higher rates of self-reported food allergies, they are less likely to have a diagnosis or food allergy treatment plan (Taylor-Black & Wang, 2012). Similarly, lower-income children are underdiagnosed and at a higher risk for fatal allergic reactions due to lacking access to healthcare and allergen-safe food (Davis et al., 2021). In a Texas study, researchers found that schools with primarily lower-income students had significantly less epinephrine auto-injectors available in their offices compared to higher socioeconomic status schools (Shah et al., 2014). Lower-income children who are a racial minority are at the highest risk of poor health outcomes given the lack of access to healthcare and life-saving resources they face both at school and in their communities (Shah et al., 2014). If you'd like to read more about racial disparities in food allergy prevalence and healthcare, click here to check out a previous literature review I did on the topic.
The Impact of Food Allergies on Low-Income Children and Families
A few Canadian studies have explored the burden that food allergies have on lower-income children (Bozen et al., 2020; Hurst et al., 2021). Researchers have found barriers that lower-income families face with managing food allergies including limited caregiver knowledge, insecure access to allergen-free foods, and insecure access to epinephrine (Bozen et al., 2020; Hurst et al., 2021). Additionally, food allergies are often comorbid with asthma and lower-income children with both of these conditions are at a higher risk for poor health outcomes due to not having access to inhalers or epinephrine (Jabre et al., 2020). In a study on Canadian food-allergic street youth, researchers found that these youths struggle to find allergen-safe food at food banks and often resort to buying expired or off-brand epinephrine injectors on the streets, which poses more health risks (Minaker et al., 2014).
The Gap: The Psychosocial Burden of Food Allergies on Marginalized Individuals and Families
Previous studies on the psychosocial impact of food allergies have primarily focused on higher-income families and found higher levels of anxiety and eating disorders among caregivers and children with allergies (Protudjer et al., 2021; Shanahan et al., 2014). Two studies that did focus on lower-income families found higher levels of social and generalized anxiety as well as feelings of shame among children with food allergies (Goodwin et al., 2017; Minaker et al., 2015). While there is important research on the economic burden of food allergies, few studies have explored their psychosocial burden on lower-income families and in particular, lower-income families of color. No studies to date, as of December 2021, have explored the needs of these families with food allergies specifically during the COVID-19 pandemic, which may in itself present a whole new set of challenges to people with food allergies.
There is some awesome research on the impact that having food allergies has on people, caregivers, and families but there is still so much more that needs to be explored. I could only find a small handful of articles that discussed the impact that food allergies has on lower-income families and only two that explored the experiences of street youth and people without housing (Minaker et al., 2014; Minaker et al., 2015). These two articles shine a light on the challenges that people without housing face in not only managing their food allergies safely, but simply surviving. It is crucial that we uplift and include these stories of people with food allergies that are often not heard about or posted online to highlight the various challenges they face and to identify ways we can take action to support them, whether that be through advocating for change in our communities and online, volunteering at local food banks and working with them to promote food allergy awareness, or getting involved in local programs that offer free Epi-Pens to those in need. Additionally, sharing this post, doing your own research, and reaching out to me if you're interested in learning more about the references I used are all great ways to spread awareness in and outside of the food allergy community on this under-researched topic. If you'd like to take further action, I highly suggest checking out and contributing to these two awesome organizations that are doing great work to support families with food allergies (https://foodequalityinitiative.org/, https://securingsafefood.org/) .
Thanks for reading!
Bozen, A., Zaslavsky, J. M., Cohn, D., Samady, W., Lombard, L., Nadeau, K., Tobin, M., Warren, C. M., & Gupta, R. S. (2020). Barriers to food allergy management among Americans with low income. Annals of Allergy, Asthma, & Immunology, 125(3), 341–343. https://doi.org/10.1016/j.anai.2020.05.007
Davis, C. M., Apter, A. J., Casillas, A., Foggs, M. B., Louisias, M., Morris, E. C., Nanda, A., Nelson, M. R., Ogbogu, P. U., Walker-McGill, C. L., Wang, J., & Perry, T. T. (2021). Health disparities in allergic and immunologic conditions in racial and ethnic underserved populations: A Work Group Report of the AAAAI Committee on the Underserved. Journal of Allergy and Clinical Immunology, 147(5), 1579–1593. https://doi.org/10.1016/j.jaci.2021.02.034
Frykas, T. L. M., Golding, M., Abrams, E. M., Simons, E., & Protudjer, J. L. P. (2021). Mothers of children with food allergies report poorer perceived life status which may be explained by limited career choices. Allergy, Asthma, and Clinical Immunology, 17(1), 12–14. https://doi.org/10.1186/s13223-021-00515-8
Goodwin, R. D., Rodgin, S., Goldman, R., Rodriguez, J., DeVos, G., Serebrisky, D., & Feldman, J. M. (2017). Food allergy and anxiety and depression among ethnic minority children and their caregivers. The Journal of Pediatrics, 187, 258–264. https://doi.org/10.1016/j.jpeds.2017.04.055
Gupta, R., Holdford, D., Bilaver, L., Dyer, A., Holl, J. L., & Meltzer, D. (2013). The economic impact of childhood food allergy in the United States. JAMA Pediatrics, 167(11), 1026–1031. https://doi.org/10.1001/jamapediatrics.2013.2376
Hurst, K., Gerdts, J., Simons, E., Abrams, E. M., & Protudjer, J. L. (2021). Social and financial impacts of food allergy on economically-disadvantaged and -advantaged families: A qualitative interview study. Annals of Allergy, Asthma, & Immunology, 127(2), 243–248. https://doi.org/10.1016/j.anai.2021.04.020
McGowan, E. C., Matsui, E. C., McCormack, M. C., Pollack, C. E., Peng, R., & Keet, C. A. (2015). Effect of poverty, urbanization, and race/ethnicity on perceived food allergy in the United States. Annals of Allergy, Asthma, & Immunology, 115(1), 85–86. https://doi.org/10.1016/j.anai.2015.04.021
Minaker, L. M., Elliott, S. J., & Clarke, A. (2014). Exploring low-income families’ financial barriers to food allergy management and treatment. Journal of Allergy, 2014(2014), 160363–160367. https://doi.org/10.1155/2014/160363
Minaker, L. M., Elliott, S. J., & Clarke, A. (2015). Low income, high risk: the overlapping stigmas of food allergy and poverty. Critical Public Health, 25(5), 599–614. https://doi.org/10.1080/09581596.2014.926309
Protudjer, J. L., Golding, M., Salisbury, M. R., Abrams, E. M., & Roos, L. E. (2021). High anxiety and health-related quality of life in families with children with food allergy during coronavirus disease 2019. Annals of Allergy, Asthma & Immunology, 126(1), 83–88. https://doi.org/10.1016/j.anai.2020.09.010
Quach, L. L., & John, R. M. (2018). Psychosocial impact of growing up with food allergies. Journal for Nurse Practitioners, 14(6), 477–483. https://doi.org/10.1016/j.nurpra.2018.03.017
Shah, S. S., Parker, C. L., O’Brian Smith, E., & Davis, C. M. (2014). Disparity in the availability of injectable epinephrine in a large, diverse US school district. The Journal of Allergy and Clinical Immunology: In Practice, 2(3), 288–293. https://doi.org/10.1016/j.jaip.2013.09.016
Shanahan, L., Zucker, N., Copeland, W. E., Costello, E. J., & Angold, A. (2014). Are children and adolescents with food allergies at increased risk for psychopathology? Journal of Psychosomatic Research, 77(6), 468–473. https://doi.org/10.1016/j.jpsychores.2014.10.005
Taylor-Black, S., & Wang, J. (2012). The prevalence and characteristics of food allergy in urban minority children. Annals of Allergy, Asthma, & Immunology, 109(6), 431–437. https://doi.org/10.1016/j.anai.2012.09.012