May 2024 Issue
Allergy-Free Eating: Food Insecurity and Food Allergies
By Sherry Coleman Collins, MS, RDN, LD
Today’s Dietitian
Vol. 26 No. 5 P. 8
A Potential Recipe for Disaster
As many as 33 million Americans have food allergies, including one in 13 children and one in 10 adults. Research shows that the economic burden of food allergies is more than $4,100 per year, and that burden is disproportionately felt across low socioeconomic and racial and ethnic minority groups.1, 2 The research on food insecurity and food allergies is still building, but thus far the news isn’t encouraging.
Lynda Mitchell, MA, CAE, CEO of Allergy & Asthma Network, a nonprofit outreach, education, advocacy, and research organization for individuals and families living with allergies, asthma, and related conditions, in Fairfax, Virginia, says, “Food allergy and food insecurity are a major issue of concern for us. It’s a health equity issue that has a more adverse impact on Black, Hispanic/Latino, and Native American individuals.”
This article will discuss the statistics regarding food insecurity and its potential overlap with food allergies, as well as explore the RD’s role in helping clients find accessible and allergy-friendly foods.
The Research
Mitchell says food-insecure individuals with food allergies are vulnerable because their socioeconomic condition makes access to safe, nutritious foods a challenge. In fact, a report by the American Academy of Allergy Asthma and Immunology’s Committee on the Underserved found that children in underserved populations are more likely to suffer anaphylaxis and visit the emergency department, are less likely to have emergency medications and experience less follow-up with specialists.3 The higher adverse events may be related to food access since the “lack of allergen-safe foods at food banks may lead individuals with food allergies to take chances eating foods that may not be safe for them,” Mitchell says.
Considering the burden of managing food allergies , providing allergy-safe foods and substitutions is the largest single cost. Milk is the most common food allergy in young children. The national average cost per gallon, according to a March price report from the USDA, is $3.20, while just a 1/2 gallon of fortified rice milk costs at least $3.82.4,5 This can have an impact across grocery categories because people with food allergies must restrict multiple foods. Higher prices also have a significantly disproportionate impact on those managing food insecurity. “People with a food allergy face the high costs of food substitutions and for some in food deserts difficulty accessing safe and nutritious options,” says Anita Roach, MS, vice president of health equity and community engagement at Food Allergy Research & Education, a nonprofit, private organization dedicated to food allergy awareness, research, education, and advocacy in McLean, Virginia.
Food insecurity impacts people of all ages but has the greatest effects on families with children. According to a USDA report, in 2022, 12.8% of all American households experienced food insecurity, but if there were children in the household, that number jumped to 17.3%.6 In a national survey of households with at least one individual with a food allergy, nearly 70% screened “at risk” for food insecurity using the Hunger Vital Sign, a validated two-question screening tool.7 This highlights the real overlap between food allergies and food insecurity, which can affect quality of life and mental wellness.
Accessing Safe Foods
To help remedy the effects food insecurity has on people with food allergies, nutrition programs such as WIC, SNAP, and the National School Lunch Program provide substitutions for those diagnosed with food allergies by a medical professional. However, families with limited access to health care specialists may have to wait months for an appointment to see an allergist and obtain a diagnosis. In the meantime, those with food allergies may not have access to safe food.
As Mitchell mentioned, since food banks and food pantries may not have adequate supplies of allergy-friendly foods, their staffs may lack the training necessary to meet the needs of individuals with food allergies. They may not stock allergen-safe products or alternatives such as gluten-free flour, soy milk, and egg-free pasta. And cross-contact can be a problem if untrained volunteers stock items that contain allergens with those that are free from allergens.
“There’s still a need for more options in the charitable food system,” says Emily Brown, cofounder and CEO of Attane Health, an organization that provides groceries and educational resources for those living with chronic health conditions, based in Kansas City, Missouri.
Clancy Cash Harrison, MS, RDN, FAND, host of The Food Dignity® Podcast and founder of the Food Dignity® Movement, a humanitarian organization that addresses food insecurity and social reform on the ground in Luzerne County, Pennsylvania, says, “Food banks and pantries play a crucial role in providing food assistance to those in need. However, the typical food banking model focuses on quantity and cost over quality and can pose challenges for individuals with food allergies and dietary restrictions.” Harrison says allowing individuals with food allergies to choose their own foods rather than prebagged options can help ensure they receive foods they can eat safely.
There are a limited number of organizations, such as Food Equality Initiative, providing home delivery of safe foods to those with food allergies and food insecurity, but these services aren’t available nationwide. Some insurers offer discounted or fully covered home-delivered meals as part of their food as medicine model to those who qualify for these benefits.
Role of RDs
Dietitians are uniquely positioned to help families manage food allergies and food insecurity. First, RDs can screen clients for food insecurity as part of their nutrition assessment. According to Roach, in a recent article she coauthored, “[Food allergic individuals] who were at risk for food insecurity using the Hunger Vital Signs tool were more likely to have worse food allergy outcomes.”7
If individuals or families are dealing with food insecurity, educate them about nutrition assistance programs that can help them based on their specific situation and needs. RDs also can tell clients about community resources, such as food banks, and provide referrals to families. Dietitians also can serve as resources to food banks by educating them about food allergies and training staff on how to handle and store allergen-free foods.
In addition to offering resources for safe food access, RDs should provide individuals and families with practical nutrition education on food allergies. Nutrition education can include instruction on label reading and involve discussion about precautionary allergen labeling, which is voluntary and unregulated, to ensure individuals can successfully avoid the allergen. Mitchel says it’s also important to consider potential language barriers for non-English speaking individuals with food allergies.
What’s more, RDs should ask questions about and seek to understand cultural foods, religious and family traditions, and diversity in how food is purchased to better counsel clients. Dietitians should discuss nutritionally appropriate substitutions and safe food handling to prevent cross-contact. And they should provide recommendations on affordable, nutrient-rich foods naturally free from the individual’s food allergen, and encourage clients to take advantage of such options from nutrition assistance programs and food banks.
Bottom Line
The goal for individuals and families with food allergies is to eat the most nutritious diet with the least restrictions possible while avoiding allergens. Understanding the barriers people with food allergies and food insecurity face is essential to removing these obstacles. Access to safe, nutritious foods is important for all people, but for those with food allergies, it can be a matter of life and death.
“There’s a growing recognition of the role of healthful food in managing chronic conditions,” Brown says. “Food allergies are a chronic condition that’s not caused by poor diet, but access to specific foods is part of the management. More needs to be done to ensure all patients have access to the right foods to thrive.” In addition to providing practical solutions for individuals with food allergies and food insecurity, RDs can join Brown and others in their advocacy to make safe foods accessible and affordable. By being engaged in local, state, and national conversations about food insecurity, RDs can represent the various vulnerable populations impacted, including those with food allergies.
— Sherry Coleman Collins, MS, RDN, LD, is president of Southern Fried Nutrition Services in Atlanta, specializing in food allergies, digestive disorders, and nutrition communications. Follow her on X, formerly known as Twitter, Instagram, and Facebook @DietitianSherry.
Resources
These organizations are improving access to safe foods for individuals with food insecurity. Share this list with clients and patients who may benefit:
• Food Equality Initiative: www.foodequalityinitiative.org
• FOODiversity: www.fooddiversity.org
• Food Allergy Research & Education Community Access Program: www.foodallergy.org
• Securing SAFE Foods: www.securingsafefood.org
• SAFE Food Pantry: www.safefoodpantry.org
• Allergy & Asthma Network: www.allergyasthmanetwork.org
• Food Allergy & Anaphylaxis Team: www.foodallergyawareness.org
References
1. Facts and statistics. Food and Allergy Research & Education website. https://www.foodallergy.org/resources/facts-and-statistics#:~:text=How%20Many%20People%20Have%20Food,roughly%20two%20in%20every%20classroom
2. Jones S, Anvari S, Coleman A, et al. Food insecurity and allergic diseases: a call to action. J Clin Immunol Allergy. 2024;153:359-367.
3. Davis CM, Apter AJ, Casillas A, et al. Health disparities in allergic and immunologic conditions in racial and ethnic underserved populations: a work group report of the AAAAI committee on the underserved. J Allergy Clin Immunol. 2021;147(5):1579-1593.
4. Advertised prices for dairy products at major retail supermarket outlets ending during
the period of 3/8/2024 to 3/14/2024. USDA Agricultural Marketing Service website. https://www.ams.usda.gov/mnreports/dybretail.pdf. Published March 8, 2024.
5. Results for rice milk. Walmart website. https://www.walmart.com/search?q=rice+milk. Accessed February 17, 2024.
6. Food security in the US. USDA Agricultural Marketing Service website. https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/#:~:text=10.5%20percent%20(13.8%20million)%20of,from%2010.5%20percent%20in%202019. Updated October 25, 2023. Accessed on February 12, 2024.
7. Sansweet S, Roach A, Pappalardo AA, Yost JC, Asante J, Warren C. Food insecurity and psychosocial burden in a national community-based sample of households managing food allergy. Health Promot Pract. 2024:15248399231223740.