Lucy Bilaver

Low-income families of children with food allergies spend 2.5 times more on emergency department and hospitalization costs nationally, according to new research conducted at Northwestern Medicine by a team including NIU Assistant Professor of Nursing and Health Studies Lucy Bilaver.

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—a drug that rapidly reduces allergic reactions­­­—or see an allergist who would counsel them on prevention and management of their food allergies.

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 physician.

“The specialists are the ones who provide a lot of education and guidance for families with food allergies, and these families are missing out on that,” said Bilaver.

Research team member Ruchi Gupta, an associate professor of pediatrics at Northwestern University Feinberg School of Medicine, said the study also shows disparities in managing food allergies.

“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 said.

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

“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.

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.

Bilaver, Gupta and the research team’s research paper was published in The American Academy of Pediatrics April 27. The study was supported by Food Allergy Research & Education.

About Lucy Bilaver:  Bilaver is an assistant professor of public health at Northern Illinois University.  She began work on childhood food allergy as a postdoctoral fellow at the Center for Healthcare Studies at Feinberg.  This research project offered an opportunity for her to extend previous work she had completed, along with Gupta, on the economic burden of food allergy.