Food Allergies and Food Insecurity in America
20 million Americans live with at least one food allergy.
6.2% (about 16 million) of adults
5.8% (about 4 million) of children
In addition, food insecurity in America is a serious public health issue.
- 10.5 of U.S. homes experienced food insecurity sometime in 2020.
- 14.5% of homes with children experienced food insecurity.
Food allergy and food insecurity together are of special concern for the nutrition, health and safety of children. One study reported that 21% of children with food allergy experienced food insecurity. That means more than 1 million U.S. children live with both food allergy and food insecurity.
Let’s take a look at these two distinct but sometimes overlapping public health issues.
What is food insecurity?
Food insecurity is defined as not having enough food or the right kinds of food to eat. This is caused by not having enough money or not being able to get to a grocery store.
People with food allergies, Celiac disease and other chronic diseases are at risk for food insecurity. This is because they may need special foods (dairy-free, gluten-free, etc.) for their diet. Sometimes it can be a challenge to find these special foods.
There are two categories of food insecurity:
- low food security
- very low food security
What is low food security?
Low food security homes have enough food, but there is less variety. The food may not always be healthy.
What is very low food security?
In very low food security homes, families make smaller meals or skip meals because there isn’t enough food. They often have reduced food intake. In 2020, 3.9% of U.S. homes had very low food security.
Who is food insecure?
Anyone can have food insecurity. It can be temporary or long term. Job loss and poverty are the most common reasons.
Food insecurity can vary by ethnicity and race. According to the USDA:
- 1 in 12 white, non-Hispanic people (8.1%) live in food insecure households.
- 1 in 4 Native American individuals (23.5%) live in food insecure households.
- 1 in 6 Latino individuals (15.8%) live in food insecure households.
- 1 in 5 Black, non-Hispanic individuals (19.3%) live in food insecure households.
During the COVID-19 pandemic, more people had problems finding enough food to eat. When people lose their jobs, it leads to more people not being able to buy the food they need for their home. It also leads to reduced food intake. Inflation is a driver of food insecurity, particularly for those who rely on government programs.
What is a food allergy?
A person with a food allergy has an immune system that overreacts to proteins certain foods. The immune system sees the allergy-causing proteins as dangerous invaders. To fight it, the body creates an antibody called Immunoglobulin E (IgE). This triggers an allergic reaction. Food allergy symptoms can involve:
- hives on the skin
- your breathing
- your heart
- your digestive system
A food allergy reaction can cause mild symptoms or severe symptoms. A severe allergic reaction to food can happen. This is called anaphylaxis and it is a medical emergency. People experiencing severe allergic reactions require emergency medication called epinephrine. They may also need to go to an emergency department or hospital.
The most common food allergies in adults are (in order):
- tree nut
- fin fish
Who has a food allergy?
Anyone can develop a food allergy at any time – even to certain foods you have eaten before with no problems.
Studies show that some racial and ethnic groups are more likely to have food allergies. Non-white/non-Hispanic adults are more likely to have a food allergy. Black and Hispanic/Latino children are more likely to have a food allergy than white, non-Hispanic children.
What else can affect food insecurity and food allergies?
Issues regarding food insecurity and food allergy include:
Racial and ethnic disparities
Black and Hispanic/Latino children are more likely to have both food allergies and food insecurity. Black children with food allergies are more likely to have low food security compared to white children.
Milk and egg allergy
Lower health literacy
Food insecurity is also associated with lower health literacy. Health literacy is an ability to understand basic health information and services. People with high health literacy are able to make more informed decisions about their healthcare.
For people with food allergies, health literacy also involves reading food labels. It’s important they be able to understand and identify allergens on food labels.
Challenges in managing allergen-restricted diets
Managing a food allergy and food insecurity is a challenge for many families. People with food allergies must avoid the foods that contain even small amounts of their allergens. Eating any amount of an allergen can result in a severe reaction with life-threatening symptoms. But avoiding food allergens is not always easy, especially for people on low incomes. With a limited budget and less access to grocery stores, allergen-free foods can be limited or not available at all.
In addition, it can be expensive to manage food allergies. It can cost more to buy special foods for people with allergies. That can impact the family budget. The average cost for special foods is $285 per year per child with food allergies. Homes with children with food allergies spend $4,184 more per year per child. This includes doctor visits, buying epinephrine auto-injectors, and purchasing special foods.
Managing food allergies could drive families who may not have been food insecure to experience food insecurity. The systems that aim to support those with food insecurity are not quite as effective for people with food allergies.
Not enough screening for food insecurity
Approximately 75% of doctors do not ask their patients if they can afford food and groceries. Most doctors don’t know if their patients have money for food. Some don’t know enough about food insecurity to talk to patients. They also don’t know how to help their patients if they couldn’t afford food.
The American Academy of Allergy, Asthma & Immunology (AAAAI) hosted a workgroup on screenings for food insecurity. The workgroup created guidance on how to set up food insecurity screening. It includes federal resources and assistance programs. One consideration is to develop a script for doctors, physician assistants and nurses to follow when discussing food allergy with patients.
A food insecurity toolkit from the Food Research & Action Center is available for doctors to use with patients. The toolkit is called Screen and Intervene: A Toolkit for Pediatricians to Address Food Insecurity. It teaches doctors how to screen patients for food insecurity. The toolkit also offers ideas on how to help them be able to buy food.
Food deserts in areas of poverty
Another problem for some families is living in a food desert. This means they live in an area that doesn’t have a grocery store nearby with healthy or allergen-free food. Food insecurity statistics show that approximately 19 million (6.2%) Americans live in a food desert.
Food deserts can be found in urban and rural areas. Poverty is common in food deserts. To determine if an area is a food desert, researchers review:
- how many stores are in an area;
- how far it is to get to those stores;
- the cost of food;
- if people can afford it;
- how easy it is to catch a bus or subway to the store.
Some people with limited access to supermarkets may have to depend on convenience stores and fast-food restaurants for meals. These meals may not contain the same quality nutrients as fresh food and may not be as healthy. For people with food allergies, this presents yet another barrier to accessing food.
Availability of allergen-free foods is limited through food banks and food assistance programs
There are several different types of food assistance programs. But options may be limited for those dealing with both food allergies and food insecurity.
The higher cost of allergen-free foods is not factored into SNAP benefits
The Supplemental Nutrition Assistance Program (SNAP) is the largest national program. It is commonly known as “food stamps.” In 2019, 10.9% of Americans received help from SNAP. SNAP benefits allow people to buy foods of their choice at the grocery store. But the benefits might not stretch as far when allergen-free foods cost more. Allergen-free foods are often 2-4 times more expensive.
Limited allergen-free substitutions in WIC food packages
WIC is the Special Supplemental Nutrition Program for Women, Infants, and Children. WIC offers food packages containing basics such as milk, eggs and bread. WIC also provides vouchers for fruits and vegetables. Some of these foods – namely milk, eggs and wheat – are common food allergens. WIC does allow for certain substitutes, but often those substitutes are not of similar quantity or quality. For people with multiple food allergies, there may be a limited benefit to these packages.
Limited allergen-free substitutions in other federally funded programs
The Summer Food Service Program (SFSP) is a federally funded, state-administered program that brings free healthy meals and snacks to children and teens in low-income areas.
The Senior Farmers’ Market Nutrition Program is a federally funded program that gives low-income seniors access to locally grown fruits, vegetables, honey and herbs.
The drawback to both of these programs is that they do not provide additional funding to local groups to cover the cost of allergen-free food substitutions.
Food banks often have limited availability of allergen-free foods
The Emergency Food Assistance Program provides access to food banks and pantries. But there is no guarantee that allergen-free foods are available. The benefit of food banks for people with food allergies may vary day to day, depending on what is available.
A 2021 study found that 70% of families eligible for food assistance programs opted out of those programs. One of the primary reasons for doing so was concern over food allergic reactions.
What can help people with food allergies who are food insecure?
Doctors and medical researchers are beginning to understand the impact of food insecurity on health. For the food allergy population, the data are still limited. But research does suggest that food insecurity is more prevalent in food-allergic people. Here are ways to help people with food allergies and food insecurity:
More screening of children with food allergies for food insecurity
Healthcare providers should consider screening food allergy patients for food insecurity. They should also seek out appropriate resources to offer patients.
More advocacy for equitable food assistance for those with food allergy
The food allergy community continues to advocate for more equitable food assistance. Advocacy can help reduce food insecurity for everyone, including those managing food allergies. “The Food Equality Initiative, AllergyStrong, and FOODiversity are organizations that advocate for people living with food insecurity and food allergy.”
Wider availability of resources to help those living with both food allergies and food insecurity
People with food allergy and food insecurity need more widespread access to these services. Here are some resources that may help.
Key takeaways regarding food allergies and food insecurity in America
- One in 10 households experience food insecurity. One in seven households with children experience food insecurity.
- Food insecurity is more common in people with food allergies. It is particularly more common in Black, Latino and Native American children with food allergies.
- Healthcare providers should consider screening people for food insecurity. They also should seek out other resources to offer patients.
- Food pantries may offer allergen-safe foods for families on low or fixed incomes.
- The food allergy community must advocate for more equitable food assistance. Advocacy leads to better policies that reduce food insecurity. Potential policy changes include:
- access to safe meals through public school systems;
- reducing restrictions on WIC allowable foods to ensure “safe” brands are accessible;
- accommodating needs of food-allergic families in food banks and food pantries;
- accommodating the needs of food-allergic families in local, state and federal agencies that coordinate nutrition programs.
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Don Bukstein, MD, FACAAI, is a board-certified allergist and immunologist and pediatric pulmonologist. He serves as Medical Director for Allergy & Asthma Network. Dr. Bukstein also volunteers at a Medicaid clinic in inner city Milwaukee. He is the former Director of Allergy and Asthma Research at Dean Medical Center in Madison, Wisconsin.