Social and financial impacts of food allergy on the economically disadvantaged and advantaged families: A qualitative interview study

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Abstract

Background

Differences in the qualitatively-perceived burden of food allergy based on economic disadvantages have not been previously described.

Objective

To describe the perceptions of food allergy–related social and financial issues of families who have a child with food allergy, considering the similarities and differences between economically advantaged and disadvantaged families.

Methods

From March to July 2019, we interviewed parents of children being followed up for food allergy at a tertiary allergy clinic in central Canada. Interviews were recorded, transcribed, and analyzed thematically. Economic groups were categorized on the basis of the national cutoffs for low-income after-tax dollars.

Results

We interviewed 18 parents (17 [94.4% mothers]) of whom 6 (33.3%) were economically disadvantaged, and who represented 25 children (10 [40.0%] girls) with food allergy. We identified 3 common themes: food allergy had (1) resulted in the need to teach others in addition to contributing to tensions in relationships; (2) increased time costs for food shopping and preparation; and (3) contributed to concerns securing qualified child care. We also identified 2 divergent themes that underscored how this burden was perceived between economic groups: (1) medications and medical appointments are costly or inconvenient; and (2) allergy-friendly food choices: single vs several sources and servings.

Conclusion

Despite some qualitative similarities in the social and financial burdens of food allergy, there are some notable differences between economic groups that underscore the need for further discussions surrounding the related policy.

Introduction

The prevalence of food allergy is between 4% and 8% worldwide.1, 2, 3, 4 In Canada, the most recent estimates of probable food allergy support a prevalence within this range, at approximately 6%.5 Because food allergy is often lifelong, those affected rely on dietary modification and strict avoidance of the foods to which they have an allergy. In the event of an accidental exposure resulting in anaphylaxis (and, thus, potentially fatal reaction), those affected rely on the use of epinephrine, usually administered through an epinephrine autoinjector (EAI). These adaptations to manage food allergy and treat reactions have exhibited a financial burden on families. For example, our group recently reported that, before the coronavirus pandemic, families of a child with a food allergy reported an excess total cost of CAD $2377 compared with families with no food allergy.6 In the United States, the societal cost of food allergy total to nearly US $24.8 billion.7

To date, the financial costs, including both direct and indirect costs, of food allergy have been most typically addressed quantitatively.6, 7, 8, 9 However, these methods do not capture the perceptions of families, which may be addressed using qualitative methods.10 To our knowledge, this has only been considered once previously. In a study of low-income families in Ontario, Canada, most of whom were receiving social support, food allergy was perceived as contributing to both excess direct and indirect costs.11 This study gleaned important insights into the burdens of food allergy among low-income families. But critical questions remain, including the perceived burden faced by those who are above the low-income cutoff, but who are nevertheless economically disadvantaged. Furthermore, a comparison of the perceived burden by economic advantage is warranted to understand which allocated resources would be most meaningful. To this end, we performed a qualitative study in which we aimed to describe the perceptions of food allergy–related social and financial issues of families in Manitoba, Canada, who have a child with food allergy, with consideration to the similarities and differences between economically advantaged and disadvantaged families.

Section snippets

Study Design and Participant Recruitment

We performed a phenomenological qualitative interview study of the lived experiences of parents of children with food allergy, as diagnosed by a pediatric allergist. Between March and July 2019, parents were recruited from a tertiary allergy clinic in Central Canada. Families were provided information and an informed consent form to review at their leisure.

Data Collection

Families who returned a consent form (either during the clinic visit or by means of post) were contacted and an in-person interview was

Results

We performed 18 in-person qualitative interviews of parents (17 [94.4% mothers]), who represented 25 children (10 [40.0%] girls) with food allergy (Table 3). In total, 6 (33.37) families were economically disadvantaged. Families had lived with food allergy for, on average, 6.19 (± 4.97) years, with a mean age at diagnosis of 2.81 (± 2.42) years. Allergies to peanut (15 of 25; 60%) and tree nuts (14 of 25; 56.0%) were most frequently mentioned. The mean number of food allergies was 2.20 (±1.58)

Discussion

In this qualitative study of perceived food allergy–related financial burdens, both economic groups described a need to educate families and community members regarding food allergy, but which often resulted in tensions and feelings of isolation. Families also spoke of time costs and the need for creative child care options. We also identified 2 divergent themes that underscored how this burden was perceived between economic groups. Shopping habits differed, with economically disadvantaged

References (26)

Cited by (6)

Disclosures: Ms Gerdts reports serving as the executive director of Food Allergy Canada and as co-lead of Canada's National Food Allergy Action Plan. Dr Abrams reports being a member of the steering committees of Canada's National Food Allergy Action Plan and Food Allergy Canada's Healthcare Advisory Board and currently serves as the section head of the Food Allergy and Anaphylaxis at the Canadian Society of Allergy and Clinical Immunology. Dr Protudjer reports being a member of the steering committee for Canada's National Food Allergy Action Plan and currently serves as the section head of Allied Health at the Canadian Society of Allergy and Clinical Immunology. The remaining authors have no conflicts of interest to report.

Funding: This study was funded by the Manitoba Medical Services Foundation (award number 8-2020-11) and the Children's Hospital Research Institute of Manitoba.

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