STUDY: Food Allergies May Be Under-Diagnosed In Children On Medicaid

A 2020 study indicates that food allergies may be under-diagnosed in children on Medicaid. Here’s what families need to know about the study’s findings.

A 2020 study led by Ruchi Gupta, M.D. (Lurie Children's Hospital of Chicago; Northwestern University Feinberg School of Medicine), Lucy Bilaver, Ph.D., and others indicates that food allergies in children enrolled in Medicaid may be under-diagnosed.

According to data from the study, less than 1% of children on Medicaid have a food allergy, a much lower percentage than the general population of children with food allergies.

The authors of this study believe that this points to inequalities in food allergy care --- that Medicaid-enrolled children with food allergies are less likely to see an allergist, and thus less likely to be diagnosed with a food allergy.

In other words, many children in lower-income families who have food allergies may never know for sure that they have food allergies. This may keep them from getting the critical allergy care they need.

Here's what families need to know about this study's findings, and what they indicate.

Food Allergy Prevalence In Medicaid-Enrolled Children Is Low

Dr. Gupta and Dr. Bilaver's 2020 study examined data from the Medicaid claims of over 23 million children, to estimate how many of these children have a food allergy. This was the first time that Medicaid claims were analyzed at this scale, to collect food allergy data.

We’ve broken down key findings from the study in the table below:

Questions Answers

What was the purpose of the study?

To determine the prevalence of food allergies among Medicaid-enrolled children

Who was included in the study?

  • 23,825,160 children:
    • All the children continuously enrolled in Medicaid in 2012
    • Children were 0-19 years old as of 1/1/2012

How did the researchers determine who had a food allergy?

Researchers analyzed Medicaid claims to see who had a food allergy diagnosis, based on International Classification of Diseases, Ninth Revision, Clinical Modification codes.

What did the results show?

0.6% of the Medicaid-enrolled population had at least one food allergy.

This was a much lower prevalence of food allergies than the general population.

What might this mean?

This might mean that food allergies are under-diagnosed in children on Medicaid (that many children on Medicaid have food allergies but don’t know it).

According to this data, 0.6% of children on Medicaid have a food allergy.

But this percentage is much lower than the estimated percentage of all children who have food allergies based on parent-report surveys (7.6%).

It is also much lower than the reported percentage of all children with doctor-confirmed food allergies (4.8%).

Since the disparity in food allergy prevalence is so great compared to the general population, this may indicate that many Medicaid-enrolled children have food allergies that aren't diagnosed. This finding surprised the study's authors.

“We were surprised to find such a large discrepancy in estimates of food allergy prevalence in children on Medicaid compared to the general population," says Dr. Gupta in a Lurie Children's Hospital press release on the study. "Our findings suggest potential under-diagnosis of food allergy among Medicaid-enrolled children."

Food Allergy Under-Diagnosis May Point To Care Barriers

Why might food allergies be under-diagnosed in children on Medicaid? It's likely because families in this lower-income population struggle to access specialty allergist care.

As Dr. Gupta states, "Families in the Medicaid program may be encountering barriers to accessing and affording specialists and potentially life-saving epinephrine prescription.”

Only an allergist can diagnose a food allergy, using one of three specialized tests (a skin prick test, a blood test, or an oral food challenge).

If a family on Medicaid can't afford an allergist visit for this testing, they can't get a definitive diagnosis of a food allergy.

And as Dr. Gupta and Dr. Bilaver found in a previous study, low-income families tend to spend less for food allergy specialist visits, suggesting that they’re less likely to visit an allergist due to costs.

The struggle to afford an allergist brings even more challenges to this population. Without access to an allergist, and without a food allergy diagnosis, children can't access the critical allergy care that they need.

Their families may not receive guidance on food allergy management, including how to identify and respond to an allergic reaction, when epinephrine is needed, and how to use an epinephrine auto-injector (an Epi-pen).

Also, they may not be able to obtain a prescription for this epinephrine, the only medicine that can stop a life-threatening food allergy reaction.

(Studies have previously shown that lower-income families are less likely to be prescribed an Epi-pen to treat allergic reactions, possibly pointing to struggles to access an allergist.)

The Study’s Findings On Race And Food Allergy

Dr. Gupta and Dr. Bilaver also gathered statistics on whether Medicaid-enrolled children of different races were more or less likely to have a food allergy.

Compared to white children, Black children were 7% more likely to have a food allergy. Asian children were 24% more likely to have a food allergy, and Native Hawaiian/Pacific Islander children were 26% more likely to have a food allergy.

Meanwhile, Hispanic and Latinx children were 15% less likely to have a food allergy than white children, and American Indian/Alaskan Native children were 24% less likely to have a food allergy than white children.

Dr. Gupta and Dr. Bilaver report that the racial differences in food allergy risk measured in the Medicaid-enrolled children are consistent with the patterns found in the general population. More research is needed on race as a possible food allergy risk, however.

Says Dr. Gupta, “Future research needs to determine whether racial and ethnic differences in prevalence are associated with disparities in adequate food allergy management, including patient education on allergen avoidance and up-to-date epinephrine prescriptions.”

What Actions Should Be Taken?

Since this study shows that food allergies may be sharply under-diagnosed in children on Medicaid, it emphasizes that actions need to be taken to improve equitable access to food allergy care in this population.

  • Financial and other barriers to accessing an allergist, including for allergy testing, must be removed. This way, more families will be able to receive a food allergy diagnosis when needed.
  • Medicaid-enrolled families must be made aware of reimbursement opportunities for allergist visits, where available.
  • Doctors must educate Medicaid-enrolled food allergy families on how to recognize the signs of an allergic reaction, and when and how to give epinephrine.
  • Epinephrine access must be improved among the Medicaid population, as epinephrine is the only medicine that can stop a life-threatening allergic reaction. Families must be able to access an allergist to receive an epinephrine prescription.

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Jessica Huhn is a Content Writer for Ready. Set. Food!

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