ABSTRACT
OBJECTIVES: To describe food allergy (FA)-related service utilization and identify factors associated with guideline-informed care among Medicaid-enrolled US children with FA. STUDY DESIGN: Retrospective cohort study. METHODS: We used the 2012 Medicaid Analytic eXtract files to identify children with an FA diagnosis. FA-related services including outpatient allergist visits, emergency department (ED) visits, epinephrine autoinjector prescription fills, and diagnostic testing were identified. Factors associated with services were assessed using logistic regression. Kaplan-Meier survival curves evaluated the time to guideline-informed care, and proportional hazard models determined associated socioeconomic characteristics. RESULTS: There were 64,276 Medicaid-enrolled children younger than 20 years who had at least 1 claim with an FA diagnosis in 2012. Minority children and those living in a high-poverty county were less likely to have visited an allergist for FA or received diagnostic testing but more likely to have an FA-related ED visit compared with White children and those not living in a high-poverty county. Survival analyses found that of children seen for FA-related primary care or an ED visit, rates of allergist follow-up visits were 21% and 17%, respectively, and rates of epinephrine autoinjector prescription fills were 39% and 41%. Significant associations with guideline-informed care were found by race/ethnicity, dense population, and high-poverty counties. CONCLUSIONS: Although guideline-informed FA care includes follow-up with an allergist and epinephrine autoinjector prescription, this study finds low probabilities of timely service utilization after medical visits, as well as socioeconomic disparities in care.
Subject(s)
Food Hypersensitivity , Medicaid , Child , Emergency Service, Hospital , Epinephrine/therapeutic use , Food Hypersensitivity/diagnosis , Humans , Retrospective Studies , United StatesABSTRACT
PURPOSE OF REVIEW: Food allergy remains a disease of global public health significance well known to impact social, emotional, and financial well being. This review aims to summarize the existing literature focused on the direct, indirect, and intangible costs of food allergy at the household and healthcare system levels, and begin to discuss how emerging treatment and prevention strategies may be leveraged to comprehensively care for the food allergic population with the efficient use of health resources. RECENT FINDINGS: Food allergy imposes significant costs to multiple stakeholders and largely impact families at the household level. Recent studies elucidate the need to balance the household management of food allergy with the efficient use of health resources. Overall, it remains critical that safe foods and medications remain affordable while further exploring the cost-effectiveness of early introduction, emerging food allergy therapies, and the wider use of stock epinephrine to adequately meet the public health needs of the food-allergic community. SUMMARY: Better understanding how the cost of food allergy impacts populations will help to inform more progressive policies aimed at lessening socioeconomic disparities and ultimately improve quality of life for children and adults with food allergies.
Subject(s)
Cost of Illness , Food Hypersensitivity/economics , Public Health/economics , Cost-Benefit Analysis , Food Hypersensitivity/epidemiology , Food Hypersensitivity/immunology , Food Hypersensitivity/therapy , Global Burden of Disease/economics , Health Care Costs/statistics & numerical data , Health Care Rationing/economics , Health Care Rationing/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Policy/economics , Health Services Needs and Demand , Humans , Quality of LifeABSTRACT
BACKGROUND: The transition from adolescence to young adulthood marks a developmental period in which responsibility for management of chronic conditions such as food allergy shifts from the caregiver to the young adult. Fatal food-induced anaphylaxis is most common among adolescents and young adults. However, colleges are currently not well positioned to provide integrated support for students with food allergies. OBJECTIVE: The study objective was to explore the systems, structures, and policies that currently support students with food allergies at college, assess unmet needs, and develop pilot interventions through the use of patient-centered design processes. METHODS: Key informant interviews were conducted with stakeholders in the campus management of food allergies (n = 26) between April and May 2016. Data were coded and assessed for relative frequencies of each code to determine challenges and potential solutions. RESULTS: The convergence of stakeholder-identified themes indicated that the transition to college for students with food allergy would be improved by providing support for: (1) Notification of others in the student's campus network about food allergy; (2) Establishing clearly defined roles/responsibilities; and (3) Increasing campus awareness of food allergy signs, symptoms, and lethality. To better provide comprehensive support for students, 5 interventions-collectively called Spotlight-were developed. CONCLUSION: The use of qualitative research methods, patient-centered design processes, and collaborations with diverse stakeholders-including pediatricians that care for adolescents-can provide a framework for designing coordinated systems and policies to provide comprehensive support to college students with food allergy. Next steps include rigorously testing implementation of the Spotlight intervention prototypes.
Subject(s)
Anaphylaxis/prevention & control , Emergency Medical Services/organization & administration , Food Hypersensitivity/prevention & control , Health Knowledge, Attitudes, Practice , Universities/organization & administration , Adolescent , Adrenergic Agonists/therapeutic use , Allergens/chemistry , Anaphylaxis/diagnosis , Anaphylaxis/physiopathology , Anaphylaxis/psychology , Epinephrine/therapeutic use , Female , Food Hypersensitivity/diagnosis , Food Hypersensitivity/physiopathology , Food Hypersensitivity/psychology , Humans , Male , Stakeholder Participation , Students/psychology , Surveys and Questionnaires , Young AdultABSTRACT
BACKGROUND: Food allergy (FA) affects 8% of children and adolescents in the United States. Nearly 40% of those affected have experienced severe reactions. Fatal food-induced anaphylaxis is most common among adolescents and young adults (AYA); however, FA-related risk behaviors persist in this population and factors associated with these behaviors remain unclear. OBJECTIVE: To characterize FA-related risk-taking and self-management behaviors of AYA with FA. METHODS: A cross-sectional survey was administered to 200 AYA with FA. Latent class analysis was used to identify distinct behavioral risk classes and predictors of risk class membership. RESULTS: Two distinct FA behavioral risk classes were identified, representing less (N = 120) and more (N = 80) risky subpopulations. After adjusting for age, sex, and anaphylaxis history, odds of more risky class membership were significantly reduced for AYA with peanut allergy (odds ratio [OR], 0.27; 95% CI, 0.11-0.65), supportive female friends (OR, 0.27; 95% CI, 0.07-0.99), overprotective mothers (OR, 0.42; 95% CI, 0.18-0.97), teachers who are aware of their FA (OR, 0.39; 95% CI, 0.17-0.91), a history of being bullied (OR, 0.22; 95% CI, 0.09-0.51), and an established 504 education plan (OR, 0.35; 95% CI, 0.15-0.81). AYA also reported numerous positive outcomes of their FA, such as greater responsibility, empathy, and improved diet, which was significantly associated with reduced odds of risky class membership (OR, 0.38; 95% CI, 0.18-0.80). CONCLUSIONS: Among AYA, increased FA-related risk-taking was associated with clinical, demographic, and social factors, including peanut allergy, greater age, as well as absence of social support and specific school FA policies. These associations may be used to inform future interventions designed to address FA-related risk and management behaviors.
Subject(s)
Anaphylaxis/psychology , Food Hypersensitivity/psychology , Risk-Taking , Adolescent , Adolescent Behavior/psychology , Adult , Age Factors , Cross-Sectional Studies , Female , Humans , Male , Social Support , Socioeconomic Factors , United States , Young AdultABSTRACT
Pediatricians are often first-line providers for children with food allergy. Food allergy management guidelines have been developed but are cumbersome and confusing, and significant variation exists in pediatricians' management practices. We therefore consolidated the guidelines into 5 key steps for pediatricians caring for patients with food allergy and used rapid-cycle improvement methods to create a clinical decision support system to facilitate the management of food allergy in the primary care setting. This report details the development of the Food Allergy Support Tool (FAST), its pilot testing in 4 primary care pediatric practices, and our ongoing efforts to improve its utility and ease of use. Key themes identified during these processes include the importance of both initial and ongoing provider education as well as the limitations of a tool that must be actively initiated by providers.
Subject(s)
Decision Support Systems, Clinical/standards , Food Hypersensitivity/diagnosis , Food Hypersensitivity/prevention & control , Practice Patterns, Physicians'/standards , Child , Child Welfare , Evidence-Based Medicine , Female , Humans , Male , National Institute of Allergy and Infectious Diseases (U.S.) , Pediatrics/organization & administration , Practice Guidelines as Topic , United StatesSubject(s)
Allergists/statistics & numerical data , Disease Management , Food Hypersensitivity/epidemiology , Parents , Pediatricians/statistics & numerical data , Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Physician-Patient Relations , Research Report , United States/epidemiology , Young AdultABSTRACT
BACKGROUND: Rates of food-induced anaphylaxis among children remain uncertain. In addition, little is known about the demographics of children who have experienced food-induced anaphylaxis resulting in emergency department (ED) visits and/or subsequent hospitalizations. OBJECTIVES: To evaluate trends in ED visits and hospital admissions due to food-induced anaphylaxis among Illinois children and to identify socioeconomic variation in trend distribution. METHODS: Illinois hospital discharge data compiled by the Illinois Hospital Association were used to identify ED visits or hospitalizations for food-induced anaphylaxis in Illinois hospitals from 2008-2012. Data for children aged 0 to 19 years who were Illinois residents and received a diagnosis of food-induced anaphylaxis based on International Classification of Diseases, Ninth Revision, Clinical Modification codes (995.60 through 995.69) were included for analysis. RESULTS: There was a significant increase in the rate of ED visits and hospital admissions due to food-induced anaphylaxis among children in Illinois during the 5-year period, with an annual percent increase of 29.1% from 6.3 ED visits and hospital admissions per 100,000 children in 2008 to 17.2 in 2012 (P < .001). Increases in visit frequency were observed for all study variables, including age, sex, race/ethnicity, insurance type, metropolitan status, hospital type, and allergenic food. Visits were most frequent each year for Asian children and children with private insurance. However, the annual percent increase in visits was most pronounced among Hispanic children (44.3%, P < .001) and children with public insurance (30.2%, P < .001). CONCLUSION: ED visits and hospital admissions for food-induced anaphylaxis have increased during a 5-year period among children in Illinois, regardless of race/ethnicity and socioeconomic status.
Subject(s)
Anaphylaxis/epidemiology , Emergency Service, Hospital/statistics & numerical data , Food Hypersensitivity/epidemiology , Hospitalization/statistics & numerical data , Adolescent , Chicago/epidemiology , Child , Child, Preschool , Ethnicity/statistics & numerical data , Female , Hospitals, General/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Humans , Illinois/epidemiology , Infant , Infant, Newborn , Insurance, Health/statistics & numerical data , Intensive Care Units, Pediatric/statistics & numerical data , International Classification of Diseases , Length of Stay/statistics & numerical data , Male , Morbidity/trends , Patient Admission/statistics & numerical data , Social Class , Suburban Population/statistics & numerical data , Urban Population/statistics & numerical data , Young AdultABSTRACT
Although peanut allergy is among the most common food allergies, no study has comprehensively described the epidemiology of the condition among the general pediatric population. Our objective was to better characterize peanut allergy prevalence, diagnosis trends, and reaction history among affected children identified from a representative sample of United States households with children. A randomized, cross sectional survey was administered to parents from June 2009 to February 2010. Data from 38,480 parents were collected and analyzed in regard to demographics, allergic symptoms associated with food ingestion, and methods of food allergy diagnosis. Adjusted models were estimated to examine association of these characteristics with odds of peanut allergy. Of the 3218 children identified with food allergy, 754 (24.8%) were reported to have a peanut allergy. Peanut allergy was reported most often among 6- to 10-year-old children (25.5%), white children (47.7%), and children from households with an annual income of $50,000-$99,999 (41.7%). Although peanut allergy was diagnosed by a physician in 76% of cases, significantly more peanut allergy reactions were severe as compared with reactions to other foods (53.7% versus 41.0%, p < 0.001). Parents were significantly less likely to report tolerance to peanut as compared with the odds of tolerance reported for other foods (odds ratio 0.7, 95% confidence interval: 0.5-0.9). Childhood peanut allergy, which represents nearly a quarter of all food allergy, presents more severe reactions and is least likely to be outgrown. Although it is diagnosed by a physician in nearly three-fourths of all cases, socioeconomic disparities in regard to diagnosis persist.
Subject(s)
Peanut Hypersensitivity/epidemiology , Adolescent , Age of Onset , Child , Child, Preschool , Female , Food Hypersensitivity/epidemiology , Humans , Infant , Infant, Newborn , Male , Odds Ratio , Peanut Hypersensitivity/diagnosis , Prevalence , Public Health Surveillance , Severity of Illness Index , Socioeconomic Factors , United States/epidemiology , United States/ethnologyABSTRACT
Our goals were to (1) estimate the rates of parent-reported versus physician-diagnosed food allergy, (2) determine pediatrician adherence to national guidelines, and (3) obtain pediatricians' perspectives on guideline nonadherence. A mixed method approach was used, including survey, chart review, and qualitative methods. Overall, 10.9% of parents reported having a child with food allergy and two thirds of these cases were detected by the pediatrician. Chart reviews revealed high rates of guideline adherence with respect to allergist referral (67.3%), but less consistent adherence regarding documentation of reaction history (38.8%), appropriate use of diagnostic tests (34.7%), prescription of epinephrine autoinjectors (44.9%), and counseling families in food allergy management (24.5%). Pediatricians suggested that poor adherence was due to lack of documentation, familiarity with guidelines, and clarity regarding the pediatrician's role in managing food allergy. Findings emphasize the need to better establish the role of the pediatrician and to improve awareness and adherence to guidelines.
Subject(s)
Food Hypersensitivity/diagnosis , Food Hypersensitivity/therapy , Guideline Adherence/statistics & numerical data , Pediatrics/standards , Practice Patterns, Physicians'/statistics & numerical data , Adolescent , Child , Child, Preschool , Counseling , Epinephrine/administration & dosage , Female , Food Hypersensitivity/epidemiology , Humans , Infant , Male , Physician's Role , Practice Guidelines as Topic , Primary Health CareABSTRACT
Food allergy is a public health problem that affects nearly 6 million children in the United States. The extent to which children, families, and communities live with food allergies varies as much as the range of clinical symptoms associated with the disease itself. Food allergy is defined as the reproducible adverse event that elicits a pathologic immunoglobulin E (IgE)-mediated or non-IgE-mediated reaction. Once an allergic child ingests a specific food allergen, the reaction can result in clinical symptoms ranging from mild hives to life-threatening anaphylaxis.Not surprisingly, food allergies have been shown to limit social interactions and impair children's quality of life due to the ubiquity of food where children live, learn, and play. To ensure the safety of our children, the development of sound policy, clinical practice, and health programs must be informed by current research characterizing childhood food allergy at the population level. To set the stage for understanding the current evidence base, this article reviews: 1) epidemiology of childhood food allergy; 2) severity of symptoms; 3) geographic distribution of childhood food allergy; 4) tolerance; 5) economic impact of childhood food allergy; and 6) future directions in childhood food allergy epidemiological research.
Subject(s)
Food Hypersensitivity/epidemiology , Adolescent , Child , Child, Preschool , Cost of Illness , Disease Progression , Food Hypersensitivity/economics , Health Care Costs , Humans , Infant , Infant, Newborn , Prevalence , Severity of Illness Index , United States/epidemiologyABSTRACT
Food allergy is a growing public health concern in the United States that affects an estimated 8% of children. Food allergy is defined as an adverse health effect arising from a specific immune response that occurs reproducibly on exposure to a specific food. Nearly 40% of children with food allergy have a history of severe reactions that if not treated immediately with proper medication can lead to hospitalization or even death. The National Institute of Allergy and Infectious Diseases (NIAID) convened an expert panel in 2010 to develop guidelines outlining evidence-based practices in diagnosing and managing food allergy. The purpose of this review is to aid clinicians in translating the NIAID guidelines into primary care practice and includes the following content domains: (1) the definition and mechanism of childhood food allergy, (2) differences between food allergy and food intolerance, (3) the epidemiology of childhood food allergy in the United States, (4) best practices derived from the NIAID guidelines focused on primary care clinicians' management of childhood food allergy, (5) emerging food allergy treatments, and (6) future directions in food allergy research and practice. Articles focused on childhood food allergy were considered for inclusion in this review. Studies were restricted to the English language and to those published within the past 40 years. A cross-listed combination of the following words, phrases, and MeSH terms was searched in PubMed and Google Scholar to identify relevant articles: food allergy, food hypersensitivity, child, pediatric, prevalence, and epidemiology. Additional sources were identified through the bibliographies of the retrieved articles.