PDF《of焖ood Allergy》

19 Chapter

2 A Review of?the?Distribution and?Costs of?Food Allergy Ruchi?S.

?Gupta, Alexander?M.?Mitts, Madeline?M.?Walkner, and?Alana?Otto 2.1? Introduction Food allergy is a significant disease and requires attention in both medicine and society. It affects 8% of U.S. children (Gupta et?al. 2011) and there is no established cure for food allergy yet. Moreover, potential allergen exposure and the risk of severe allergic reactions are part of daily life. Epinephrine auto-injectors (EAIs) are the only approved treatment for severe allergic reactions, and access to these devices among food-allergic children is not always possible. Food-allergic people and their caretakers are forced to be constantly vigilant, often at great psychological and financial cost. Food allergy is more likely to occur in African American and Asian children than White children, and the rate of reactions requiring emergency department (ED) visits or hospitalizations is growing fastest among Hispanic children (Dyer et?al. 2015). Importantly, formal diagnoses and access to treatment are less likely among racial/ ethnic minorities than among White children. Lower income families also have limited access to preventative measures but spend more than twice what higher-income fami- lies do on emergency department visits for food-allergic reactions. Urban children R.S. Gupta (*) ? A.M. Mitts Northwestern University Feinberg School of Medicine, 750?N.?Lake Shore Drive 6th FL, Chicago, IL 60611, USA e-mail: [email protected] M.M. Walkner Ann &

Robert H.?Lurie Children'

s Hospital of Chicago, Chicago, IL 60611, USA A. Otto Northwestern University Feinberg School of Medicine, 750?N.?Lake Shore Drive 6th FL, Chicago, IL 60611, USA Ann &

Robert H.?Lurie Children'

s Hospital of Chicago, Chicago, IL 60611, USA

20 have also been shown to have higher numbers of food allergy diagnosis and higher rates of ED visits than those living the in suburbs. These disparities, together with the large size of the affected population, make childhood food allergy a serious public health problem. Increasing public access to information about food allergy and its treatment is vital. It has been demonstrated that the quality of life among parents of children with food allergy is worse than that of parents of non-allergic children. This difference exists even among parents who feel comfortable with controlling their children'

s food allergies. Avenues to improve quality of life among food-allergic children and their caregivers have been largely unexplored. At the consumer level, there is a great deal of ambiguity in the regulation and meaning of allergen warnings on packaged foods, which may lead to misinformed and potentially dangerous food purchases. From an economic stand- point, food allergy costs the US $24.8 billion annually (Gupta et?al. 2013);

much of this cost is borne by the families of food-allergic children (Gupta et?al. 2013). Schools exist at the intersection of the many spheres discussed above and repre- sent an opportunity to improve outcomes for food-allergic children around the country. Chicago Public Schools (CPS) is the largest school system to date to implement a program to make undesignated epinephrine available for any student experiencing anaphylaxis. This program has potentially saved dozens of lives but has also cast into sharp relief about the disparities in and necessity of access to EAIs. The data gleaned from the CPS initiative should motivate us to increase safety and awareness around food allergy. This chapter will aim to make clear the state of food allergy in the U.S., and on which parties the burden of the disease lies. The studies discussed herein aimed to gather and organize population-level information on the prevalence, distribution, and cost of food allergy, as well as to understand some of the social and psychological responses to the challenges of food allergy. 2.2? The Prevalence, Severity, and?Distribution of?Childhood Food Allergy in?the?U.S. There is a lack of comprehensive data on both the number of children in the U.S. living with food allergy, and their demographics. Efforts to characterize the scope of the disease have been limited by small and non-representative samples as well as by the use of non-standardized diagnostic criteria (Gupta et?al. 2011). We therefore conducted a population-based, cross-sectional survey of a large representative popu- lation of U.S. children (n?=?38,480) in an attempt to define the prevalence and sever- ity of pediatric food allergy in the U.S. Recruitment employed a dual-sample approach, in which a probability-based sample statistically representative of U.S. households with children was used to identify and correct for a sampling and non-? sampling bias introduced by a larger, opted-in online sample (Gupta et?al. 2011). In this survey, prevalence estimates include report of both convincing allergy, defined as participant report of a food allergy plus a history of one or more common symp- toms, and confirmed allergy, defined by the criteria of a convincing allergy plus