Why low-income kids with food allergies end up in the ER more often

Food allergies are created equal, so it would seem to stand to reason that children would be affected equally. But among kids with food allergies, those in low-income families go to the emergency room more often, according to a new study published in the journal Pediatrics.

The study found that low-income families spend 2.5 times more on hospitalization costs for their children with food allergies than higher income families do. And those with lower incomes spend less than half of what other families spend on preventive measures.

The problem is these children's families often lack access to, and funds for, individualized diets, specialists and emergency drugs such as epinephrine, said Ruchi Gupta, a Northwestern University School of Medicine pediatrician who authored the study..

Another possible factor may be that, according to previous studies, more low-income children are not properly diagnosed, she said. And that could contribute to their higher rate of emergency room visits, said Gupta.

Dr. Jonathan Tam, who heads the Gores Family Food Allergy Center at Los Angeles' Children’s Hospital, said it sometimes comes down to a tough choice.

"Two parents work two jobs each and one of the children has food allergy; that is important, but getting the next paycheck is a little more important or the asthma that the kid also has is a little more important," he said. "So the problem goes down on their list of problems."

Gupta said food allergies are a little different from other conditions.

"It does require a good amount of funds if you are going to avoid your allergen," she said.  Researchers surveyed around 1,700 families and asked about the costs they incurred dealing with food allergies.

Families with means may shop at specialty stores, cook more at home or even pull back on work hours to be more available to a child with a food allergy, she said. Low-income families may not have those options, added Gupta.

She suggested that grocery stores could help out by expanding their options.

"There needs to be access for all families to be able to eat safe foods," said Gupta. "Why not have affordable foods in a grocery store in an aisle that is allergen free?"

Tam said this is part of a broader issue because low-income families interact with the medical system differently from other groups.  So while food allergies might be a preventible, outpatient condition, low-income families rely on the emergency room because they can’t get time off from work for scheduled appointments or because they don’t have transportation or the money to pay a specialist.

Physicians need to help patients work through these challenges, he said. Gupta said pediatricians can help parents identify low-cost prevention options - like discounts offered by some manufacturers for epinephrine - and to advise parents on creating plans for when a child has an allergic reaction.