Food allergy affects more than 33 million people in the United States — about 1 in 10 adults and 1 in 13 children — and the newly released “National Indicator Report on Food Allergy” offers insights on the growing public impact.
The report was written by Christopher M. Warren, PhD, assistant professor at Northwestern University Institute for Public Health and Medicine, Feinberg School of Medicine, in Chicago, with extensive input and approval from members of the Food Allergy AWARE Advisory Council, which includes primary care clinicians, public health professionals, and those affected by food allergy.
The project is funded by the CDC and was released by Food Allergy Research & Education (FARE) during the American Academy of Allergy, Asthma & Immunology Annual Meeting.
Among the report highlights:
- Of the more than 27 million US adults with food allergy, about half developed at least one food allergy in adulthood, and 21% say all of their food allergies began after age 18.
- Only about 5200 allergists practice in the US, which translates to 1.6 allergists per 100,000 people.
- Food allergy’s societal costs in the US are $370.8 billion, with a per-patient annual cost of about $22,000.
- Epinephrine is often underused, despite proven safety and effectiveness. In a cross-sectional survey of individuals with food allergy, only 24% of adults and 40.7% of children reported having a current epinephrine prescription. Those aged 50 years or older were significantly less likely to report having an active epinephrine prescription.
- States differ widely on access to allergists. New York, for instance, has the second-highest number of allergists in the nation (500) but the lowest rate of allergists who accept Medicaid (13.4%). California, with 683 allergists, has a Medicaid acceptance rate of 72.3%.
Allergen Prevalence Differs by Age and Race
Among children, the most common food allergen is peanuts (2.2% of the population), followed by milk (1.9%), shellfish (1.3%), tree nuts (1.2%), and egg (0.9%). The most common food allergens in adults are shellfish (2.9%), milk (1.9%), peanut (1.8%), tree nuts (1.2%), and fish (0.9%).
The report also notes differences by race and ethnicity. In the pediatric population, Black children had the highest rates of peanut allergy (3.0%), egg allergy (1.6%), and finfish allergy (0.9%). Asian children had the highest prevalence of tree nut allergy (2.0%). Asian adults had the highest rates of peanut allergy (2.9%) and shellfish allergy (3.8%); Black adults had the top prevalence of tree nut allergy (1.6%); and Hispanic adults had the highest rates of egg allergy (1.2%) and finfish allergy (1.5%).
Most US Counties Have No Allergist
Geographic access to allergists is also varied, the report notes. A 2019 study using data from 3527 physicians found that 81.5% of US counties had no allergists and the disparity was stark between rural and urban areas: “Only 0.3% of rural counties had an allergist compared to 23.2% of urban counties.”
Over recent decades, education efforts and options have increased in food allergy, and this report aims to detail the status of the sector all in one place, Kelly Cleary, MD, medical director and vice president of health and education for FARE, told Medscape Medical News.
Some of the most exciting developments have been oral immunotherapy, biologics, and new modes for receiving epinephrine, she said. She notes that the report discusses alpha-gal, an IgE [immunoglobulin E]-mediated food allergy, triggered by tick bites, which is increasing in prevalence.
Report Addresses Psychosocial, Financial Burden
“It also recognizes some of the things that really weren’t talked about as much a decade ago, and those are the burdens of food allergy — the psychosocial impact, the economic burden,” Cleary said.
Access is a huge issue, she pointed out. As an example, Wyoming is listed in the report as having three allergists in the state. “And only one accepts Medicaid,” she pointed out. “What if that one allergist stops accepting Medicaid?” she said. “I was really astounded by the numbers.”
Access to allergists is critical, she said, because “it’s hard for primary care docs to know what is best for each patient within food allergy.”
Cleary said she hopes this report makes patients and caregivers more aware of advances in the field and expanded options. For the non-food-allergy community, she said, “I hope that the burden of food allergy is recognized, that food allergy is understood to be a disease and not just a food preference.”
Financial disclosures were not included with the report.
Marcia Frellick is an independent, Chicago-based medical journalist and a regular contributor to Medscape.
