Patients on government assistance face challenges accessing allergen-free food

LOUISVILLE, Ky. — Access to allergen-free food is difficult for families with food allergies who receive government assistance, according to a presentation at the American College of Allergy, Asthma & Immunology’s annual scientific meeting.

Alissa A. Frame, BA, a medical/PhD student in the Department of Pharmacology at Boston University School of Medicine, called access a challenge for families using the Women, Infants and Children (WIC) and Supplemental Nutrition Assistance Program (SNAP).

“We hypothesized that consistent access to allergen-free options through these programs would be associated with improved quality of life,” Frame told Healio.

The researchers recruited 53 caregivers of children ages 0 to 17 with food allergies from an allergy clinic at Boston Medical Center, an urban hospital with a safety net. These families included 28 who did not use WIC, 12 who used WIC and reported consistent access to allergen-free food, and 13 who used WIC and reported inconsistent access.

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“When we asked, they had sometimes, rarely, or never had access,” Frame said.

These caregivers completed an online cross-sectional survey that included socioeconomic and demographic information, a food allergy-related quality of life questionnaire, and use of WIC, SNAP, and food bank programs.

“The Quality of Life Questionnaire looked at a number of sub-scores, like food allergy anxiety. Are you stressed all the time from being exposed?” Framework says. “Do you live in fear Are you disappointed with how people react or adapt to your limitations?

Just over 20% of children had one food allergy, while the rest all had multiple food allergies, Frame said. The most common allergen was peanuts, followed by tree nuts, eggs, milk, sesame seeds and soy. Caregivers reported difficulty accessing options through WIC and SNAP for each of these allergens.

“When you break it down by allergy, and when you watch it all together as well, less than half of the people who responded were able to have consistent access to those food options through WIC or SNAP,” Frame said.

These difficulties were compounded when children had multiple food allergies, with those with more than one food allergy appearing to be significantly more likely to have inconsistent access to allergen-free food options via the WIC (P < .01).

“We think it’s probably because a lot of the alternatives also contain a major specific allergen,” Frame said.

For example, the researchers pointed out that common dairy-free alternatives often include soy, which many of these children are also allergic to.

Overall, the researchers found that multiple food allergies (P < 0.001) and inconsistent access to allergen-free foods via WIC and SNAP (P < 0.05) were significantly associated with poorer food allergy-related quality of life.

“If you use WIC and have consistent access, the quality of life score was actually the same as people who didn’t use WIC at all,” Frame said. “But when you have inconsistent access to the food options you need, the quality of life goes down.”

When researchers asked caregivers which allergen-free foods they wanted WIC to provide, four said they wanted dairy alternatives, and two said they would like Ripple Milk, an allergen-free vegan milk. Nut-free butter, cereal and snack alternatives, fruit and special preparations were also mentioned by one caregiver each. Yet these options can be hard to find.

“A lot of families who use WIC and SNAP live in food deserts,” Frame said. “The places they can go won’t necessarily have soy- and dairy-free alternatives to milk.”

Getting to stores that offer these options is also difficult, given the need to find transportation to these places and take the time to travel.

“You don’t have the money to go out there and buy those options,” Frame said.

Additionally, Frame said WIC and SNAP do not provide extra money for families with food allergies.

“If you have a certain amount of money to use for milk but you need Ripple milk, you can’t get what you need,” Frame said. “So you’re working with a functionally lower budget.”

Physicians should keep these difficulties in mind when meeting with these families, Frame said.

“It’s really easy to say, ‘OK, here, fill out this form for WIC, fill out this form for SNAP, and go on your way and get what you need,'” Frame said. “Understand that these families probably need a little more support to be able to find these foods.”

Frame also hopes this data will be useful in driving policy changes that would help these families get the help they need.

“It’s difficult because most of these programs work by providing cash for food. But you have families who live in places where those foods aren’t even available,” she said. “But if a family has a documented food allergy or even, honestly, a self-reported allergy, giving them more money to buy those foods would be an easy starting point.”

In the meantime, more research is needed, Frame said.

“We need to take a closer look at the link between the number of food allergies and access and quality of life, because obviously these things can feed into each other, to see what’s really driving the train there,” said she declared. “It’s a complicated picture, but it’s actionable, and it’s one way we can help improve the quality of life for these families.”

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American College of Allergy, Asthma & Immunology Annual Scientific Meeting