Social and financial impacts of food allergy on the economically disadvantaged and advantaged families: A qualitative interview study
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)
- et al.
Food allergy: a review and update on epidemiology, pathogenesis, diagnosis, prevention, and management
J Allergy Clin Immunol
(2018) - et al.
Temporal trends in prevalence of food allergy in Canada
J Allergy Clin Immunol Pract
(2020) - et al.
Pediatric food allergy-related household costs are influenced by age, but not disease severity
World Allergy Organ J
(2019) - et al.
Household costs associated with objectively diagnosed allergy to staple foods in children and adolescents
J Allergy Clin Immunol Pract
(2015) - et al.
Qualitative analysis of perceived impacts on childhood food allergy on caregiver mental health and lifestyle
Ann Allergy Asthma Immunol
(2020) - et al.
High anxiety and health-related quality of life in families with children with food allergy during coronavirus disease 2019
Ann Allergy Asthma Immunol
(2021) - et al.
Parents of children with food allergy: a qualitative study describing needs and identifying solutions
Ann Allergy Asthma Immunol
(2020) - et al.
Becoming the parent of a child with life-threatening food allergies
J Pediatr Nurs
(2015) - et al.
A phased approach to resuming suspended allergy/immunology clinical services
J Allergy Clin Immunol Pract
(2020) - et al.
Reflections on virtual care for chronic conditions during the COVID-19 pandemic
Can J Diabetes
(2021)
Epinephrine auto-injectors: first-aid treatment still out of reach for many at risk of anaphylaxis in the community
Ann Allergy Asthma Immunol
Predicting access to healthful food retailers with machine learning
Food Policy
Food insecure and allergic in a pandemic: a vulnerable population
J Allergy Clin Immunol Pract
Cited by (6)
Managing food allergies at school: A qualitative study
2023, Journal of Pediatric NursingSocial disparities in early childhood prevention and management of food allergy
2023, Journal of Allergy and Clinical ImmunologyParental perceptions of a novel subsidy program to address the financial burden of milk allergy: a qualitative study
2023, Allergy, Asthma and Clinical ImmunologyA review of food allergy-related costs with consideration to clinical and demographic factors
2023, Current Opinion in Allergy and Clinical ImmunologyUpdate on clinical research for food allergy treatment
2023, Frontiers in AllergyThe Economic Burden of Food Allergy: What We Know and What We Need to Learn
2022, Current Treatment Options in Allergy
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.