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Golding MA, Bhamra M, Harbottle Z, Ben-Shoshan M, Gerdts JD, Roos LE, Abrams EM, Penner SJ, St-Vincent JA, Protudjer JLP. An investigation of a novel milk allergy-friendly food supplement program. FRONTIERS IN ALLERGY 2024; 5:1301834. [PMID: 38957544 PMCID: PMC11217183 DOI: 10.3389/falgy.2024.1301834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 06/05/2024] [Indexed: 07/04/2024] Open
Abstract
Introduction Compared to households not managing food allergy, households managing food allergy are faced with greater direct and indirect costs. To address these cost burdens, we developed and piloted a milk allergy-friendly food supplement program for lower- and middle-income households managing a dairy allergy in a child age <6 years. Herein, we aimed to evaluate to the impact of this program on food costs, food security, and caregiver mental health using a longitudinal design. Methods Participants living in or near the city of Winnipeg, in Manitoba, Canada were recruited from January to February 2022 via social media, word-of-mouth, and a database maintained by the principal investigator. Consenting participants took part in a 6-month allergen-friendly food supplement program that provided them with biweekly deliveries of allergen-friendly foods free of charge. To evaluate the impact of the program on food costs, food security, and well-being, participants completed a series of questionnaires at baseline, mid-point, and at the end of the program. Changes in these variables were assessed via a series of Friedman tests. Results The final sample was comprised of 8 households. Relative to baseline, participants reported higher total direct food costs at midpoint (+5.6%) and endpoint (+13.5%), but these changes did not reach statistical significance. In contrast, total indirect food costs decreased over the course of the study relative to baseline (midpoint = -28.2%; endpoint = -18.5%), but the changes were not found to be statistically significant. Participants did, however, report a statistically significant decrease in costs related to lost time from work or school as a result of their child's food allergy at endpoint relative to baseline (-100%). Few changes in food security, caregiver well-being, or child food allergy quality of life were noted. Discussion The provision of allergen-friendly foods helped keep grocery costs below the pace of inflation. Participants also reported reduced costs associated with missed time from work or school as a result of their child's food allergy. Despite these encouraging findings, a relatively high proportion of the current sample reported experiencing food insecurity throughout the study period, suggesting that additional financial support for families is needed.
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Affiliation(s)
- Michael A. Golding
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Manvir Bhamra
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Zoe Harbottle
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Moshe Ben-Shoshan
- Department of Allergy and Immunology, McGill University, Montreal, QC, Canada
| | | | - Leslie E. Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Elissa M. Abrams
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Sara J. Penner
- Department of Business and Administration, University of Winnipeg, Winnipeg, MB, Canada
| | | | - Jennifer L. P. Protudjer
- The Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Caner N, Efe YS, Söyünmez S, Bayat M. Managing food allergies at school: A qualitative study. J Pediatr Nurs 2023; 73:58-66. [PMID: 37647789 DOI: 10.1016/j.pedn.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The prevalence of childhood allergic diseases, including food allergies, has increased globally. Parents and children have experienced psychosocial and financial difficulties, decreased quality of life, anxiety, and depression in the management of food allergies in schools. PURPOSE The aim of the study was to determine the challenges experienced by mothers of children with food allergies during their children's school life. DESIGN A qualitative phenomenological study design was used. METHODS Online interviews were conducted with 9 mothers who have children with food allergies between June-August 2022. The data were analyzed using the content analysis method. The COREQ checklist was used in the study. RESULTS The ages of the mothers participating in the study ranged from 28 to 40. Four themes were generated from 75 codes: 1) Problems experienced in the process of utilizing health services, 2) Burden of care, 3) Coming out of the shell: The school process, and 4) Environmental and social perspective. CONCLUSIONS Mothers carried the burden of food allergy management during the school process, and the increased burden of care negatively impacted mothers emotionally, physically, and socially. Also, mothers were anxious about the safety of their school-age children with food allergies and their experiences with school administration, teachers, and other parents made it difficult for food allergy management in the school environment. CLINICAL RELEVANCE Children with chronic health problems such as food allergies need to be closely monitored by a health professional in school to ensure their safety. Nurses have a pivotal role in supporting families to address their child's food allergies competently, hence fostering positive health outcomes. This study showed that there was a need for the development of school health policies to ensure the safety of children with food allergies and to reduce anxiety and care burden among mothers.
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Affiliation(s)
- Nuray Caner
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey
| | - Yağmur Sezer Efe
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
| | - Selin Söyünmez
- Erciyes University, Institute of Health Sciences, Child Health and Disease Nursing Department, Kayseri, Turkey.
| | - Meral Bayat
- Department of Pediatric Nursing, Faculty of Health Sciences, Erciyes University, Kayseri, Turkey.
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Bhamra M, Harbottle Z, Golding MA, Ben-Shoshan M, Roos LE, Abrams EM, Penner SJ, St-Vincent JA, Protudjer JL. Parental perceptions of a novel subsidy program to address the financial burden of milk allergy: a qualitative study. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2023; 19:65. [PMID: 37516877 PMCID: PMC10385888 DOI: 10.1186/s13223-023-00828-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Approximately 6-7% of Canadian children have food allergy. These families face substantial burdens due to the additional costs incurred purchasing allergy-friendly products necessary for management compared to families without food allergies. In the year prior to the COVID-19 pandemic, these costs were equivalent to an average of $200 monthly compared to families without food allergy. As food prices continue to rise, rates of food insecurity also increase, disproportionately affecting households with food allergy who have limited choices at food banks. METHODS Families living or working in Winnipeg, Canada with an annual net income of about $70,000 or less the year prior to recruitment and a child under the age of 6 years old with a physician diagnosed milk allergy were recruited between January and February 2022. Participating families received bi-weekly home deliveries for six months, from March to August 2022, of subsidy kits containing ~$50 worth of milk allergy-friendly products. Semi-structured interviews, completed ± 2 weeks from the final delivery, were audio-recorded, transcribed verbatim, and analyzed thematically. RESULTS Eight interviews, averaging 32 min (range 22-54 min), were completed with mothers from all different families. On average, mothers were 29.88 ± 4.39 years old and children were 2.06 ± 1.32 years old. All children reported allergies in addition to milk. Based on the data from these interviews, we identified 3 themes: food allergy causes substantial burden for families, "I have to get his allergy-friendly food first before getting to my basic needs", and perceived emotional and financial benefits of a milk allergy-friendly food subsidy program. CONCLUSIONS This study, along with previous research, suggests that there is a need for assistance for families managing milk allergies. It also provides important information to inform development of programs which can address these financial challenges. Our in-kind food subsidy was perceived as having a positive impact on food costs and stress associated with food allergy management, however, parents identified a need for more variety in the food packages. Future programs should strive to incorporate a greater variety of products to address this limitation.
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Affiliation(s)
- Manvir Bhamra
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Zoe Harbottle
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Michael A Golding
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Moshe Ben-Shoshan
- Department of Allergy and Immunology, McGill University, Montreal, QC, Canada
| | - Leslie E Roos
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Elissa M Abrams
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Sara J Penner
- Department of Business and Administration, University of Winnipeg, Winnipeg, MB, Canada
| | | | - Jennifer Lp Protudjer
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB, Canada.
- The Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada.
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada.
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
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Fowler J, Lieberman J. Update on clinical research for food allergy treatment. FRONTIERS IN ALLERGY 2023; 4:1154541. [PMID: 37520143 PMCID: PMC10379782 DOI: 10.3389/falgy.2023.1154541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023] Open
Abstract
The incidence of IgE-mediated food allergy (FA) has continued to increase over the years which places substantial burden on patient health and quality of life. With no cure for this disease, the mainstay of management has been allergen avoidance. However, there have been advancements in FA treatment in recent years with multiple clinical trials utilizing novel and innovative therapeutic strategies. A landmark event came in 2020 with the first drug approval for food allergy with the approval of a product for peanut oral immunotherapy. In addition to oral immunotherapy, different delivery systems of immunotherapy (SLIT, EPIT) are being studied in addition to probiotics, biologic agents - used as monotherapy and as an adjunct, and modified allergens has taken place with the hope to further enhance existing therapeutic options. The hope through these continued developments is for therapies to emerge that will provide a more comprehensive benefit to this patient population.
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Golding MA, Protudjer JLP. A review of food allergy-related costs with consideration to clinical and demographic factors. Curr Opin Allergy Clin Immunol 2023; 23:246-251. [PMID: 37185830 DOI: 10.1097/aci.0000000000000903] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW To provide an overview of the magnitude and sources of food allergy-related costs, with a particular emphasis on the recent literature. We also aim to identify clinical and demographic factors associated with differences in food allergy-related costs. RECENT FINDINGS Recent research has expanded upon previous studies by making greater use of administrative health data and other large sample designs to provide more robust estimates of the financial burden of food allergy on individuals and the healthcare system. These studies shed new light on the role of allergic comorbidities in driving costs, and also on the high costs of acute food allergy care. Although research is still largely limited to a small group of high-income countries, new research from Canada and Australia suggests that the high costs of food allergy extend beyond the United States and Europe. Unfortunately, as a result of these costs, newly emerging research also suggests that individuals managing food allergy, may be left at greater risk of food insecurity. SUMMARY Findings underscore the importance of continued investment in efforts aimed at reducing the frequency and severity of reactions, as well as programs designed towards helping offset individual/household level costs.
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Affiliation(s)
- Michael A Golding
- The Children's Hospital Research Institute of Manitoba
- Department of Pediatrics and Child Health
| | - Jennifer L P Protudjer
- The Children's Hospital Research Institute of Manitoba
- Department of Pediatrics and Child Health
- Department of Food and Human Nutritional Science, University of Manitoba
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Dupuis R, Phipatanakul W, Bartnikas LM. Social disparities in early childhood prevention and management of food allergy. J Allergy Clin Immunol 2023; 151:37-41. [PMID: 36608981 PMCID: PMC9830563 DOI: 10.1016/j.jaci.2022.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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Fong AT, Ahlstedt S, Golding MA, Protudjer JLP. The Economic Burden of Food Allergy: What We Know and What We Need to Learn. CURRENT TREATMENT OPTIONS IN ALLERGY 2022; 9:169-186. [PMID: 35502316 PMCID: PMC9046535 DOI: 10.1007/s40521-022-00306-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 02/04/2023]
Abstract
Purpose of Review Food allergy management and treatment require dietary modification, are associated with significant burdens, and affect food choices and behaviours. Emerging therapies, such as oral immunotherapy (OIT), provide a glimmer of hope for those living with the condition. Some burdens have received substantial focus, whereas many knowledge gaps on the significance of other impacts, including economic burden, remain. Recent Findings Evidence from many countries, but disproportionately from the United States, supports that food allergy carries significant healthcare and societal costs. Early introduction for the prevention of food allergies is theoretically cost-effective, but remains largely undescribed. Unique considerations, such as those to cow’s milk protein allergy, which affects a substantial proportion of infants, and adrenaline autoinjectors, which have a high cost-per-use, require a balance between cost-effectiveness to the healthcare system and adverse outcomes. Household costs have largely been explored in two countries, but owing to different healthcare structures and costs of living, comparisons are difficult, as are generalisations to other countries. Stock epinephrine in schools may present a cost-effective strategy, particularly in economically disadvantaged areas. Costs relating to OIT must be examined within both immediate benefits, such as protection from anaphylaxis, and long-term benefits, such as sustained unresponsiveness. Summary Although the absolute costs differ by region/country and type of food allergy, a consistent pattern persists: food allergy is a costly condition, to those who live with it, and the multiple stakeholders with which they interact. Supplementary Information The online version contains supplementary material available at 10.1007/s40521-022-00306-5.
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Affiliation(s)
| | - Staffan Ahlstedt
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
| | - Michael A. Golding
- The Children’s Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
| | - Jennifer L. P. Protudjer
- Centre for Allergy Research, Karolinska Institutet, Stockholm, Sweden
- The Children’s Hospital Research Institute of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- Department of Pediatrics and Child Health, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- George and Fay Yee Centre for Healthcare Innovation, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
- Food and Human Nutritional Sciences, The University of Manitoba, 501G-715 McDermot Avenue, Winnipeg, MB R3E 3P4 Canada
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