8 minute read
Assessing Allergies' Cost
by Virginia Nowakowski, MPH with Dr. Lucy Bilaver, PhD
If the warming weather has ever made your nose run or your eyes water, you are not alone. Millions of Americans suffer from allergic symptoms like these each year. In many cases, taking a simple antihistamine is enough to clear up any problems, but not all allergies are the same. While spring weather may cause sneezing or a slight rash for individuals with seasonal allergies, eating the wrong meal can send people with peanut allergies into a state of anaphylactic shock.
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Regardless of the severity of the allergy, there is no doubt that allergies are widespread in the United States. Between allergic rhinitis, respiratory allergies, skin allergies, and food allergies, more than 50 million Americans suffer from some kind of allergy, and many will deal with this problem their whole lives, making allergies the sixth leading cause of chronic illness [1]. While allergies may seem like an individual’s problem, the prevalence of allergies is actually a major public health concern. Allergies, especially among the 5.6 million children who deal with food allergies, require extensive management in order to protect individuals’ health. That management comes at a cost to both families and society. Northwestern’s Dr. Lucy Bilaver, PhD, was one of the first researchers to quantify the economic burden of children’s food allergies when she worked with a team to examine caregivers’ reports of costs related to allergy care [2]. The researchers’ 2013 analysis provided a clearer look into how families manage allergies as well as how much allergies actually cost.
“We didn't really have an estimate prior to that study of the scope of the economic burden,” Bilaver says. “We found in adding up all these different types of costs that the total economic burden of food allergy was just under $25 billion – spent annually.”
The researchers measured costs that would typically be part of managing an allergy, including both direct medical costs to the healthcare system, as well as indirect medical costs that were borne by the family. Most of the direct medical costs included what one might expect in caring for any chronic condition – for one, more visits to the doctor.
“A family might initially discuss an allergic reaction or concern of a food allergy with a pediatrician, but usually there is some more specialized testing, such as skin testing, that would happen in a special allergy visit,” Bilaver says. “Usually an allergist would recommend a yearly visit – seeing an allergist on a regular basis would be an important part of standard care.”
In addition to regular doctors’ visits, families dealing with allergies may need to consider medications for daily management or for rescue, in cases of accidental exposure to the allergen. Epinephrine auto-injectors are a common, quite expensive treatment individuals keep on hand for occasions when a serious allergic reaction like anaphylaxis develops. However, Bilaver notes that with the use of epinephrine often comes another direct medical expense: an emergency room visit.
Emergency room visits for an allergic reaction are more frequent than one might hope. Recent research by Dr. Ruchi Gupta found that one in five children with a food allergy received care at an emergency room in the last year [3]. Should an individual with allergies require more care after an emergency room visit, such as an in-patient hospitalization, the cost increases even more.
Between outpatient visits, emergency room visits, and in-patient hospitalizations, the 2013 Northwestern study found that America’s healthcare system paid $4.3 billion annually in allergy care for children with food allergies [2]. Though substantial, the number explained less than a quarter of the total costs for food allergies that caregivers reported in the study. Other crucial elements to consider in allergy care economics are what things families forgo or seek out to make sure that their child stays healthy. Caregivers may lose pay for a day of work if they have to use the time to drive their child to an appointment. Families may have to pay for medications not fully covered by insurance.
For families dealing with food allergies specifically, there is a challenge to buy and cook food that will be safe for their affected family member to eat. Congress made the task a little easier in 2004 by passing the Food Allergen Labeling and Consumer Protection Act (FALCPA) [4]. The act, which came into full effect in 2006, requires consumer packaged food companies to clearly note if their product contains any of the “top eight” food allergens: milk, eggs, fish, crustacean shellfish, tree nuts, peanuts, wheat, or soybeans [5]. If a product contains any of these ingredients, the ingredient must either be written in bold in the main ingredient list or listed separately in a “Contains: allergen” statement [5]. Similar rules exist for agricultural foods, such as meat, poultry, and egg products that fall under the USDA’s inspection [6]. Of course, many individuals react to allergens outside of these lists, demanding they more carefully scan ingredient labels. Additionally, FALCPA does not require companies to include advisory statements about potential cross-contamination of their products, which may occur in facilities where companies make some foods with allergens and other foods without them [5]. These warnings indicating that a food was made on shared equipment that also processed allergencontaining products can be lifesaving for individuals with very severe food allergies – but companies include them at their own discretion.
“In the way in which food is produced, there are issues of cleaning equipment and using shared production lines for allergen-free foods and allergen-containing foods,” Bilaver says. “There is an opportunity for changes in policy around food precautionary labels in order to make them a more effective tool for families who deal with food allergies.”
On top of finding special foods, seeking medical care, paying for medications, and potentially losing days of work — the caregivers in the 2013 Northwestern study noted that in some cases their child’s allergy required seeking mental health services or changing schools, summer camps, or daycares to ensure safety from accidental exposure.
Altogether, out-of-pocket expenses accounted for more than a quarter of food allergy costs in the 2013 analysis, about $5 billion [2]. The biggest chunk of costs in the analysis, $14 billion, came from “foregone labor market activities” [2]. These opportunity costs included the money “lost” when caregivers had to change careers or give up some career options to help manage an allergic condition –further increasing allergies’ financial burden for families.
Northwestern’s 2013 study demonstrated just how costly it can be to care for an allergy. Its findings made Bilaver wonder how individuals from limited socioeconomic backgrounds handled their allergy management. She examined the data again in a 2016 study to look at how caregivers from different socioeconomic backgrounds managed the financial burden of allergies. The research revealed that families from lower income backgrounds spent more on emergency room visits and hospitalizations than higher income individuals, and less on out-of-pocket costs [7].
It may seem strange that lower income individuals would spend more on expensive emergency room visits and hospitalizations, but for Bilaver, this trend could indicate that low income individuals are struggling to afford preventive medications and management that would help them avoid emergency care. Their difficulty to pay for regular allergy management could be a crucial insight for programs seeking to improve allergy outcomes and reduce hospitalizations for allergies, highlighting the public health importance of Northwestern’s research.
As a chronic illness that places a large financial burden on individuals, families, and the country, allergies present an opportunity for members of the public health field to explore the condition’s impact on different individuals and communities. Most strategies for dealing with this issue currently rely on management. However, Bilaver points to emerging research on the prevention of allergies, noting it could present new solutions for allergy care.
According to the most recent guidelines published by the American Academy of Pediatrics, introducing peanuts to infants’ diets helps decrease sensitivities to the food [8]. Similar practices to expose children to allergens early on in their lives could potentially reduce sensitivities and protect individuals from developing an allergy in the first place. The method could certainly be cost-saving, if evidence continues to support its effectiveness.
Perhaps in the future allergies will become an entirely preventable condition, reducing the financial burden for individuals, facilities, and society. Until then, research like Bilaver’s calls attention to the importance of creating effective public health strategies to manage allergies.
About the Author
Virginia Nowakowski, MPH, graduated from Northwestern’s Program in Public Health in spring of 2019. She currently serves as an associate program manager for Bright Pink, a national nonprofit dedicated to preventing breast and ovarian cancer and improving women’s health. An alumna of the Medill School of Journalism, Virginia enjoys working at the intersection of health and communication.
Special thanks to Dr. Lucy Bilaver, PhD, whose research and expertise informed this article. Dr. Bilaver is an applied health services researcher at Northwestern University Feinberg School of Medicine. Her work focusesonpediatrichealthissues, specifically children with food allergies and autism spectrum disorder, producing research to improve policies related to children’s health.
References [1 ]CDC. “Allergies and Hay Fever.“ 2017. https://www.cdc.gov/ nchs/fastats/allergies.htm [2] Gupta, Ruchi, Holdford, David, Bilaver, Lucy. “The Economic Impact of Childhood Food Allergy in the United States.” 2013. https://jamanetwork.com/journals/jamapediatrics/ fullarticle/1738764 [3] Lurie Children’s Hospital. “One in Five Kids with Food Allergies Treated in Emergency Department in Past Year.” 2018. https:// www.luriechildrens.org/en/news-stories/one-in-five-kids-withfood-allergies-treated-in-emergency-department-in-past-year/ [4] Roses, JB. “Food allergen law and the Food Allergen Labeling and Consumer Protection Act of 2004: falling short of true protectionforfoodallergysufferers.” 2011. https://www.ncbi.nlm. nih.gov/pubmed/24505841 [5] FDA. “Food Allergen Labeling And Consumer Protection Act of 2004 Questions and Answers.” 2006. https://www.fda.gov/food/ guidanceregulation/guidancedocumentsregulatoryinformation/ allergens/ucm106890.htm#q4 [6] FSIS. “Allergies and Food Safety.” 2016. https://www.fsis.usda. gov/wps/portal/fsis/topics/food-safety-education/get-answers/ food-safety-fact-sheets/food-labeling/allergies-and-food-safety/ allergies-and-food-safety [7] Bilaver, Lucy, Kester, Kristen, Smith, Bridget, Gupta, Ruchi. “Socioeconomic Disparities in the Economic Impact of Childhood Food Allergy” 2016. https://pediatrics.aappublications.org/ content/137/5/e20153678 [8] Sicherer, Scott. “New guidelines detail use of ‘infant-safe’ peanut to prevent allergy.” 2017. https://www.aappublications. org/news/2017/01/05/PeanutAllergy010517
