The hidden price of food allergy: Understanding the social and financial burdens on families

Abstract

Food plays a unique role in culture and identity. For families managing food allergy, the role of food is complex and juxtaposed against the need to avoid known allergens, lest they risk an accidental exposure. While avoidance is simple in its instruction, the hidden prices of food allergy, namely the social and financial burdens on families, are substantial and fluid across the lifespan and in an era of rapid change in food allergy management and therapy. Families face significant impairments in quality of life, health‐related quality of life, and food allergy anxiety, in addition to disproportionately higher food costs. The emergence of new food allergy therapies is exciting, but similarly carries high costs, which may not be in the financial reach of many families. Indeed, as a result of excess food costs compared to families not managing food allergy, families managing food allergy are at theoretically higher risk of being food insecure. Owing to these hidden prices, it behooves all involved in the care of patients with food allergy to ensure appropriate diagnoses (i.e., by an Allergist), alongside an allied health team committed to supporting the psychological and nutritional needs of the family.

Abbreviations

EAI

epinephrine autoinjector

FAQLQ

food allergy quality of life

HRQL

health‐related quality of life

IMPAACT

Impairment Measure for Parental Food Allergy‐Associated Anxiety and Coping Tool

OIT

oral immunotherapy

PRO

patient‐reported outcome(s)

QOL

quality of life

SOFFA

Scale of Food Allergy Anxiety

Key message.

For families managing food allergies, the role of food in society is complex and juxtaposed against the need to avoid known allergens, lest they risk an accidental exposure. Patient‐reported outcomes, including quality of life, health‐related quality of life, food allergy anxiety, and food costs, are all exacerbated in the context of food allergies. While these outcomes are considerable and warrant discussion with families, they are also situated within the duality of food inflation and security as well as the rapid, high cost changes of food allergy management and therapy. Interprofessional allergy care is increasingly recognized as an essential way to provide comprehensive patient care, including the provision of resources and support for the psychological and nutritional needs of the family.

A diagnosis of food allergy is commonly followed with guidance to avoid the food, lest it trigger a potentially severe allergic reaction. ¹ While simple in its instruction, such guidance may be challenging to implement in practice. Indeed, the very roles of food in culture and society, and in expressions of emotion are directly challenged by a food allergy diagnosis and subsequent management.

Further complicating the management of food allergy is the disproportionately greater associated costs, whether they be direct, indirect or intangible costs (Figure 1), compared to families not managing this condition. Direct costs refer to the out‐of‐pocket costs absorbed by the family; in the context of food allergy, these include but are not limited to food, medication and therapy. Indirect costs refer to time and opportunity losses due to the time needed to manage, in this case, food allergy. Intangible costs refer to burdens that affect a family's well‐being; although these costs are non‐monetary, they may have adverse impacts on patient‐reported outcomes (PRO). Examples of intangible costs include impaired health‐related quality of life (HRQL), psychological stress and social isolation. Collectively, these costs—or burdens—were highlighted nearly a decade ago by Sicherer and Sampson, who wrote that “[t]he financial costs and emotional effect of living with food allergy cannot be underestimated”. ¹ This review discusses the hidden prices of food allergy, namely the social and financial burdens on families, and offers some ideas to prompt further conversation and action to support families managing this condition.

FIGURE 1.

Types and examples of costs of food allergy to the family.

1. FOOD ALLERGY AMIDST INCREASED SOCIETAL INTEREST IN HEALTH AND HEALTH (MIS)INFORMATION

Undoubtedly, the prevalence of food allergy has increased in recent decades. While up to 40% of people may believe that they have a food allergy, global estimates are closer to about 7%. This overestimation of food allergy is curious and may be partly due to the increased societal interest in health, as well as confusion about the distinction between food allergy and other non‐allergic gastrointestinal disorders and food intolerances. ² , ³ , ⁴ There are many and diverse reasons why an increased societal interest could be perceived as positive. From adding more nutritious ingredients to existing products to the introduction of new “superfoods” into mainstream food supply chains, there is potential for increased nutrition. Such interest may also contribute to a society that is eager to adopt behaviors that help manage or even prevent some adverse health conditions. Health trends abound, during which time any particular trend may garner substantial interest, peak, and then potentially diminish. Such trends, though, may have unintentional adverse impacts, such as the perpetuation of misinformation for bona fide conditions that are managed through health behaviors, such as what a person eats. The unintended impacts of greater societal interest in health and waves of health trends are almost certainly not entirely positive for families managing food allergy. For example, the current trend of high protein intake has likely contributed to food manufacturers' decisions to add cow's‐milk‐based and/or plant‐based protein powders in food products that would not typically contain cow's milk or plant‐based proteins. Moreover, labels such as “vegan” or “vegetarian” are not typically regulated. Thus, it is incumbent on the consumer to read all ingredient lists, even if front‐of‐package labels have health claims. Food allergen labeling legislation has known gaps, as the introduction of new foods has outpaced the ability to mandate more comprehensive lists of food allergens on product packaging. Such gaps may place consumers managing food allergy at risk for allergic reactions or the presentation of new allergies on account of the introduction of foods that unknowingly cross‐react to a known food allergen. While perhaps a less‐immediate physical threat, misinformation about food allergy abounds in lay publications and social media. Yet, this misinformation is nonetheless a threat if it is incorrectly accepted by the allergy community based strictly on the reported credentials of who provides the information or the validation of the information by someone who reports lived experience. ⁵ To be clear, social media can and should play a role in the dissemination of true expert‐informed food allergy knowledge. Combatting misinformation, however, is similarly important. The collective adverse impacts of the overestimates of food allergy, coupled with increased societal interest in health also highlight needs for the correct diagnosis of food allergy. Indeed, whether or not the diagnosis is appropriately made, the diagnosis results in mandatory changes to diet and lifestyle changes. The downstream effects of these changes will have social and financial burdens on families.

2. SOCIAL BURDENS OF FOOD ALLERGY

As humans, we are social creatures. Similarly, we often gather over food. For families with food allergy, the very ability to participate in gathering requires careful navigation. Compared to outside the home, food allergy is often easier to manage inside the home. Yet, families are reminded to triple‐check all ingredients. This reminder is well‐heeded, given that many, if not a majority (37% to 68%) of anaphylaxis cases are reported to have occurred at home. ⁶ , ⁷ , ⁸ Outside the home, food allergy must always be top of mind, from bringing their own food to social gatherings to not being invited to certain events due to others' predeterminations that the child's allergies cannot be accommodated, and limiting time spent with extended family who are not willing to learn about the child's food allergies. These external influences are substantial. In some cases, however, families may have all necessary supports, yet choose to decline an invitation on account of food allergy‐related concerns.

Children typically spend a majority of their waking hours in early childcare and/or school settings. In these settings, student to teacher ratios may be considerable. Moreover, teachers may have variable, if any, formal food allergy training. ⁹ , ¹⁰ As such, it may fall to parents to advocate for the safety of their child in such settings. It is beyond the scope of the present paper to critique the roles, safety, and utility of bans on food allergens in schools or similar settings. Suffice it to say, however, that such bans are often met with controversy. Parents of children with food allergy and teachers must also work together to ensure food allergy awareness and emergency preparedness. Similarly, clear communication between the school and all parents whose children attend the school, regardless of whether the child has food allergy or not, must be in place. Infants and young children have unique considerations, including pre‐literacy and being too young to (fully) understand food allergy management needs. While all children with food allergy are potentially vulnerable to exposure to their allergen, a particularly significant level of caution is needed for children who, based on their developmental age, are messy eaters, may place objects in their mouths, and who have not learned how to read a food label. Children may also be involved in craft work, which involves awareness of ingredients that may not be top‐of‐mind. Many craft supplies, ranging from milk‐based paints to bird seed, may include possible food allergens. While food allergy management involves unique considerations for infants and younger children, all children with food allergy are at risk for anaphylaxis. Indeed, in a 2021 review and practical guidelines statement, a median estimate of 9% of all pediatric anaphylaxis occurs in schools. ¹¹

In brief, the tensions between food and food allergy in social settings are impossible to ignore and must be navigated carefully and uniquely within each particular setting. Moreover, these tensions are dynamic and will evolve as the child matures. To this end, an understanding of PRO, measured over time, is essential. While various PRO have been considered in association with food allergy, the following two sections detail those which have garnered considerable attention: quality of life (QOL), HRQL, and food allergy anxiety.

3. QUALITY OF LIFE AS A CRITICAL CORE OUTCOME

QOL instruments have been used widely for both healthy populations and those managing diverse conditions. The impact of being cognizant of the ingredients in every food item eaten, lest the potential for an allergic reaction on QOL, cannot be understated. As this impact is the direct consequence of a health condition, namely food allergy, the result must similarly be considered in the context of health. To date, the existing literature on food allergy includes both measures of QOL and HRQL. Although these constructs measure different items and thus glean different information, they are distinct. Thus, interpretations of studies involving these constructs ought to be considered through the lens of the instrument used. However, as the extant literature has, broadly speaking, involved measures of QOL, HRQL, and food allergy QOL, this section provides a broad overview of findings involving these constructs. Indeed, recent reviews of the burden of food allergy on both caregivers ¹² and children/teens ¹³ support that QOL and HRQL were the most studied psychosocial constructs in food allergy. The collective evidence supports that QOL and HRQL are lower among those managing food allergy, compared to healthy controls. Yet, among those managing food allergy, there are important within‐group differences.

For many parents, independent of food allergy, learning how to fully care for an infant can be a major life change. Food allergy is a condition commonly diagnosed in infancy, a time which coincides with the new parents learning how to take care of their infant generally. At such a young age, the patient almost certainly is not aware of their condition, much less understands the management‐associated burdens that impact on QOL and HRQL. These burdens are carried by the parents. Golding et al. qualitatively themed the burden at time of diagnosis as “a big thing at first,” noting the shock of diagnosis caused parents to question if and how they could keep their child safe. ¹² In time, parents found “more of an even keel”. ¹⁴ While these qualitative findings are neither QOL nor HRQL per se, they nonetheless offer important narratives to the initial impacts of a food allergy diagnosis.

The type and number of foods to which a person is allergic may contribute to how they experience food allergy. While the risk of anaphylaxis is often top‐of‐mind for those managing food allergy, the severity of a previous reaction or being prescribed an epinephrine autoinjector is collectively inconsistently associated with HRQL. ¹⁵ , ¹⁶ , ¹⁷ , ¹⁸ , ¹⁹ The number of food allergies may be predictive of worse HRQL amongst parents of children and adolescents, ¹⁵ , ¹⁶ but may have less impact amongst children themselves ²⁰ and adults. ¹⁸

Parents and children with food allergy often report differences in QOL ²¹ and HRQL. ¹⁵ Less is known, however, about how parents of children experience HRQL with consideration to age. As noted above, the initial diagnosis of food allergy is a challenging time as parents learn to adjust to their new reality. ¹² Yet, compared to parents of children ages 0–5 years with food allergy, those whose children are 6–12 years have significantly worse HRQL overall, and within the domains of food anxiety and emotional impact (all p < .05), but curiously not within the domain of social and dietary limitations. ¹⁶ Adults with food allergy also reported impaired HRQL overall and within domains that relate to allergen avoidance and dietary restrictions, whereas minimal impact has been identified for food allergy‐related health. ¹⁸

The interaction between age and sex, and HRQL is complex and variable. Compared to males with food allergy, females tend to have worse HRQL across populations. ¹⁵ , ²² Similarly, compared to fathers, mothers report worse QOL for themselves and their child with food allergy. ²¹ To explore how and when age‐ and sex‐specific differences begin to present, Thörnqvist et al. studied sex‐ and age‐group specific HRQL differences amongst 137 Swedish adolescents and adults with food allergy. ¹⁶ Whereas HRQL tended to remain stable amongst women from ages 13–17, 18–39, and 40+ years, different patterns were identified for males. Compared to males ages 13–17 years, those aged 18–39 years had significantly worse HRQL overall, and within the domains, allergen avoidance and dietary restrictions, and emotional impact (both p < .05). Interestingly, no such differences were found for the domain, risk of accidental exposure, or when comparing those ages 40+ to 13–7 years. ¹⁶ Taken collectively, HRQL amongst those managing food allergy is differentially affected across the life course. Elsewhere, Vazquez‐Ortiz et al. have provided a detailed and practical summary of resources to support adolescents and young adults with food allergy, including support for HRQL, as they transition to self‐management. ²³

The impacts of food allergy on HRQL or even more specifically, food allergy QOL, are increasingly recognized. Yet, as we are living in an era of rapid change in primary and secondary prevention, and evolving ways of managing food allergy, the impact of these changes warrants substantial consideration.

Awareness and understanding of the threshold of reactivity levels, or the amount that a person may tolerate without experiencing an adverse reaction, ²⁴ may provide confidence and modest lifting of total food avoidance. A Danish study of Danish children, adolescents, and adults with peanut, hazelnut, and/or egg allergy provides evidence that lower thresholds for peanut, but not egg and hazelnut, are associated with poorer HRQL. ¹⁵ An Australian group reported, however, that such improvements may be sex‐specific. ²⁵ Compared to children of the same sex receiving a placebo, males receiving peanut OIT or peanut OIT + probiotic had improved HRQL, whereas little difference was found for females. ²⁵

Food allergy therapies, including oral immunotherapy (OIT) and omalizumab, may have important PRO benefits for those managing food allergy. Otani et al. studied parents whose children were receiving oral immunotherapy (OIT) for multiple foods or rush OIT to multiple foods + omalizumab, versus parents whose children were not receiving OIT. ²⁶ Compared to the latter group, HRQL was found to both statistically and clinically improve with OIT with or without omalizumab. ²⁶ These varied HRQL outcomes across studies reflect differences in the assessment instruments used and domains explored.

Interestingly, the domains within the most commonly used instruments to assess HRQL amongst those with food allergy differ by age group and respondents; only one domain—emotional impact—is consistent across all instruments, and only parent‐reported instruments query food anxiety or food‐related anxiety ²⁷ (Table 1).

TABLE 1.

Domains within the Food Allergy Quality of Life series of instruments.

Questionnaire	Domains
	Allergen avoidance and dietary restrictions	Allergen avoidance	Dietary restrictions	Emotional impact	Food allergy‐related health	Food‐related anxiety	Risk of accidental exposure	Social restrictions	Social and dietary limitations
Completed by patient
FAQLQ‐CF		x	x	x			x
FAQLQ‐TF	x			x			x
FAQLQ‐AF	x			x	x		x
Completed by parent
FAQLQ‐PF				x		x			x

Note: Adapted from Reference [27].

Abbreviations: FAQLQ‐AF, Food Allergy Quality of Life‐Adult Form; FAQLQ‐CF, Food Allergy Quality of Life‐Child Form; FAQLQ‐PF, Food Allergy Quality of Life‐Parent Form; FAQLQ‐PFT, Food Allergy Quality of Life‐Parent Form Teenager; FAQLQ‐TF, Food Allergy Quality of Life‐Teen Form.

4. FOOD ALLERGY ANXIETY

The preceding section underscored the importance of considering both overall and domain‐specific impacts of food allergy on HRQL. Indeed, when examining the collective literature, the emotional impact of food allergy on HRQL often plays a significant role. ¹⁶ , ²⁸ This observation, coupled with inadequate tools to measure anxiety amongst those managing food allergy, ²⁹ may have prompted greater interest in a novel type of anxiety, unrelated to other circumstances in their lives, namely food allergy anxiety. As described by Polloni and Muraro, food allergy is explained by food allergy‐specific anxiety, as opposed to a tendency to anxiety generally. ³⁰

Food allergy anxiety likely exists along a theoretic continuum (Figure 2). Appropriate levels of food allergy anxiety may prompt behaviors that support food allergy management. Examples of such behaviors include EAI carriage, label reading, and planning ahead to ensure that safe foods are available. In contrast, too little anxiety may not prompt such behaviors, whereas excess or maladaptive anxiety may be counterproductive through imposed limitations of activities despite implementing food allergy management behaviors.

FIGURE 2.

Theoretic continuum of food allergy anxiety.

Families managing food allergy may be screened in an Allergist's office for mental health and related support. Commonly promoted and used instruments for these purposes include the Patient Health Questionnaire and Generalized Anxiety Questionnaire. ³¹ There is no doubt that while these instruments have good utility for screening overall mental health, such instruments are not food allergy‐specific. ³² , ³³ While early work provided much‐needed evidence that anxiety was worse in families with versus without food allergy, ³⁴ further information was needed to understand these differences, deliver meaningful patient care, and develop tailored resources. Food allergy anxiety is emerging as an important PRO that better encapsulates the anxiety experienced as a direct result of a food allergy diagnosis than other anxiety constructs that are imprecise for food allergy. ²⁹ In this light, allergy professionals involved in screening families may wish to consider the use of disease‐specific tools.

Both patient‐ and parent‐facing instruments exist to measure food allergy anxiety (Table 2). The Scale of Food Allergy Anxiety (SOFAA) exists in both child‐ and parent‐rated measures, for which both short‐ and long‐forms are available. ³⁵ Importantly, the authors reported strong convergence between both the short and long versions for both respondent groups, and with reliability over time. ³⁵ The Impairment Measure for Parental Food Allergy‐Associated Anxiety and Coping Tool (IMPAACT) is, as the name implies, intended for parents of children with food allergy and includes four subscales: cognitive, behavioral, anxiety impact and child coping. ³⁶ At the time this review was written, IMPAACT is the only instrument for which normative cut‐offs exist. ³⁷ Such cut‐offs may provide insight into levels of minimal, moderate or severe anxiety. ³⁷ While these cut‐offs have not yet been clinically validated, they may be useful when used in combination with clinical reasoning for screening for food allergy anxiety. ³⁷ , ³⁸

TABLE 2.

Existing instruments to measure food allergy anxiety.

Instrument (Reference)	Age for which use is intended	Respondent	Number of items	Subscales	Normative data
SOFAA 35	Parents of children ages 8–18 years	Parent	Full: 21 Brief: 7	—	No
	8–18 years	Child	Full: 21 Brief: 14	—	No
IMPAACT 36	0–17 years	Parent	28	1 Cognitive 2 Behavior 3 Anxiety Impact 4 Child Coping	Yes

Abbreviations: IMPAACT, Impairment Measure for Parental Food Allergy‐Associated Anxiety and Coping Tool; SOFFA, Scale of Food Allergy Anxiety.

In a narrative review published in 2025, Dahlsgaard and Lewis described the importance of proximity challenges for patients with food allergy anxiety. ³⁹ Such challenges, which may involve touching or smelling an allergen as part of routine practice, may function similarly to cognitive behavioral therapy, ³⁹ and may empower patients to be confident near their allergen without experiencing anxiety. ⁴⁰

5. THE COLLISION OF DESIRE FOR MENTAL HEALTH SUPPORTS, FEW ALLERGY‐INFORMED PROVIDERS, AND HIGH COSTS OF SERVICES

We are living in an era with an increasing need for mental health services. ⁴¹ The previous section detailed how food allergy‐related mental health needs are substantial and distinct from the mental health needs faced by those without food allergy. Moreover, food allergy‐related mental health needs are highly variable over the life course, ¹² , ¹³ , ¹⁵ , ¹⁶ , ⁴² with further adverse impacts subsequent to multiple reactions. ⁴³

Yet, mental health services specific to food allergy may be difficult to access. In a qualitative study from Canada, Allergists and allergy‐informed allied health professionals described resource limitations within the public health system, which may have downstream effects on families. ⁴⁴ Examples of such downstream effects may include delayed access to specialists, and in turn, delayed diagnoses and access to treatments and therapies, and inappropriate management. In an American survey of 454 caretakers of children with food allergy, 70% reported that access to mental health services would be beneficial, yet only 23% had sought such services. ⁴⁵ Similar numbers are evidenced in a global study of adults, and for parents of children with food allergy who have experienced food allergy‐related psychological distress, at 67.7% and 77.2%, respectively, while less than 20% of adults and parents of children with food allergy reported that they had been screened for such distress. ⁴⁶

Adults with food allergy face similar challenges. In a qualitative study from the UK, adults with medically‐diagnosed food allergy described a perceived lack of knowledge cross‐sectorally about food allergy, including healthcare providers, the food industry and the general public. ⁴⁷ Juxtaposed against this perceived lack of knowledge was a sense that the potential severity of their condition was dismissed. This was exemplified by one participant's comment, which in turn became the title of the publication, “Here's your EpiPen, good luck to you”. ⁴⁷

Despite the above‐described reports of psychological distress, numerous barriers to access of such services have been reported, albeit with substantial inter‐country variability. ⁴⁶ However, despite such variability, one barrier remained consistently most prominent: cost. Indeed, about one in three adults (33.0%) and parents of children with food allergy (again, 33.0%) cited cost as the most common barrier to accessing food allergy‐specific mental health supports. ⁴⁶ Yet, such costs are not the only major cost related to food allergy.

6. INCREASES IN FOOD PRICES THAT OUTPACE INFLATION

Since March 2020, which marked the debut of the COVID‐19 pandemic, food prices have significantly increased. ⁴⁸ , ⁴⁹ , ⁵⁰ Independent of food allergy, food insecurity is a major concern across the globe. ⁵¹ However, for families managing food allergy, who faced disproportionately higher food costs than families without dietary restrictions prior to the pandemic, ⁵² , ⁵³ , ⁵⁴ , ⁵⁵ , ⁵⁶ these costs are almost certainly even more impactful in the face of inflation. To ease comparisons across studies, all cost estimates reported herein were converted to Euros (€) in April 2025, without adjustments for inflation. Conversions also do not take into account differences in social structures.

Prior to the pandemic, and across nations, families with food allergy faced excess food costs. ⁵² , ⁵³ , ⁵⁴ , ⁵⁵ , ⁵⁶ One of the first studies to examine the household costs of food allergy is from Sweden, a country where all children receive school lunches at no cost, and which, when necessary, are prepared in accordance with medical dietary restrictions, such as food allergy. Despite this, Swedish families of children and adolescents with milk, egg and, or wheat allergy, reported significantly greater food costs than families without dietary restrictions, at €2085 and €2892 for adolescents, respectively. ⁵⁵ Curiously, no such costs differences were noted for adults. ¹⁸ In the United States, 1‐year all‐cause medical out‐of‐pocket household costs were substantial, albeit with notable differences between children versus adults with food allergy, at €795 versus €1330, respectively. Interestingly, food allergy‐related out‐of‐pocket medical costs were similar between the groups. ⁵⁷ In Canada, direct costs were significantly greater, by €1592 annually, for families with versus without food allergy; of this difference, 96% was driven by food costs. ⁵²

On account of the above‐described disproportionately higher food costs for those with food allergy vs. those without such dietary restrictions, ⁵⁸ those with food allergy are at a theoretically higher risk of food insecurity. While there are multiple ways to operationalize food insecurity, broadly speaking, food insecurity refers to the lack of regular access to safe, nutritious food required for growth, development, and an active life. ⁵⁹ Importantly, food insecurity exists at different levels. ⁵⁹

In 2025, Treffeisen et al. reported, based on American data from 2011 to 2018, families with a child who had a food allergy had a 39% greater odds of food insecurity, compared to families whose children do not have a food allergy. ⁶⁰ These findings were echoed and furthered by two Canadian studies, in which the authors showed that food insecurity amongst adults whose minor children have food allergies tripled from 2019 (the year prior to the pandemic) to 2022. ⁶¹ Over the same period, food insecurity amongst children with food allergies similarly increased, from 34% to 56%. ⁶²

7. ADDRESSING THE FINANCIAL BURDEN FACED BY FAMILIES MANAGING FOOD ALLERGY

Food insecurity is a difficult conversation. Yet, it behooves us as a community to start, and to normalize, these conversations. At the moment, these conversations are not routinely happening. Indeed, Shroba et al. led a study published as a work group report for the American Academy of Allergy, Asthma and Immunology, in which the authors noted that a majority of American Allergists who completed the survey did not screen their patients for food insecurity. ⁶³ The greatest barriers to screening were incomplete knowledge about screening and incomplete awareness of resources to support those identified as being food insecure. ⁶³ It also warrants mention that, in March 2025, the US Preventive Services Task Force released a recommendation that there is insufficient evidence on the benefits vs. harms of screening for food insecurity in primary care. ⁶⁴

Food banks—charitable organizations that distribute free food to families in need—are a common reality for many families. ⁶⁵ , ⁶⁶ Yet, many foods requested by food banks contain common allergens. To this end, there is an acute need for greater availability of allergen‐friendly foods in food banks and lower price‐point grocery stores. Similarly, evidence‐informed efforts to reduce cross‐contact at food banks may be beneficial, as some foods may be allergen‐friendly but not communicated as such.

For most families, the excess cost of food is likely the single greatest cost. ⁵² , ⁵³ , ⁵⁴ , ⁵⁵ , ⁵⁶ At the same time, the cost of emergency medicine, commonly in the form of an epinephrine autoinjector (EAI), cannot be ignored. Notably, the costs of such devices range widely across jurisdictions and with different insurance coverage. ⁶⁷ With an increasing number of options for food allergy therapy, other costs may also warrant consideration. On 16 February 2024, the US Food and Drug Administration approved omalizumab for the reduction of allergic reactions, including anaphylaxis, amongst children (1+ year) and adults with food allergy. ⁶⁸ While this medication offers a glimmer of hope for those with food allergy, omalizumab is an expensive drug.

Shaker et al. conducted a cost‐effectiveness analysis, in which they concluded that, at the current price point, the equivalent of about €32,500, omalizumab is not cost‐effective. ⁶⁹ The exception may be for those who have the most impairments in health state utility, particularly in a family unit. ⁶⁹ Importantly, this conclusion touched on both the cost‐effectiveness of omalizumab and the intangible costs often faced by families managing food allergy.

Looking to the future, areas of immediate need are numerous and may include cost‐effectiveness analysis of (emerging) therapies internationally, within countries and across diverse patient groups; increased capacity to offer patients therapies that are cost‐effective; and expanded capacity to under‐resourced regions and countries. By continuing to explore the family costs of food allergy and, in turn, using this information to guide shared‐decision making, we may be able to shift toward economically sustainable approaches that do not compromise patient safety or care.

8. ADDRESSING THE HIDDEN PRICE OF FOOD ALLERGY THROUGH AN INTERDISCIPLINARY LENS

There has been rapid growth in the academic understanding of food allergy in recent years. Opportunities for continuing professional development in our field need to be supported, for both physicians and allied health professionals. Such opportunities must occur in parallel with facilitated access to Allergists to improve PRO. Indeed, Dutch authors reported, compared to adult patients with food allergy who had not sought medical care for their condition, those with impaired HRQL, particularly within the domains of allergen avoidance and dietary restrictions, and emotional impact, were more likely to seek medical care. ⁷⁰

A holistic, or interdisciplinary approach to the treatment of food allergy, including support for the social and financial burdens, is likely to benefit patients and their families. While interdisciplinary teams are likely to benefit food allergy families, the construction of such teams is certain to be costly. Similarly, as formal undergraduate academic training for health professionals does not always include food allergy, additional training may be necessary. For example, the knowledge of food allergy among dietitians correlates to their length of practice, ⁷⁰ while many are not fully familiar with guidelines for early introduction as a means of primary prevention, or with risk factors for peanut allergy. ⁷¹

The integration of non‐Allergist professionals into the health team creates the potential for an Allergist to serve more families, as Allergist healthcare visits will be medically focused. Similarly, interdisciplinary teams are likely to improve patient outcomes, while also potentially decreasing long‐term social and financial burdens. These actions are likely to be beneficial whether working with newly diagnosed patients, patients struggling with food allergy anxiety, or patients wanting to explore emerging therapies.

9. CONCLUSION

The hidden prices of food allergy, namely the social and financial burdens on families, are substantial, and fluid across the lifespan and in an era of rapid change of food allergy management and therapy. Owing to these hidden prices, it behooves all involved in the care of patients with food allergy to ensure appropriate diagnoses (i.e. by an Allergist), alongside an allied health team committed to supporting the nutritional and psychological needs of the family.

AUTHOR CONTRIBUTIONS

Jennifer L. P. Protudjer: Writing – original draft; funding acquisition; writing – review and editing; visualization; project administration; resources.

CONFLICT OF INTEREST STATEMENT

JLP Protudjer is Section Head, Allied Health; and Co‐Lead, Research Pillar for the Canadian Society of Allergy and Clinical Immunology, and is on the steering committee for Canada's National Food Allergy Action Plan. She reports consulting for Ajinomoto Cambrooke, Novartis, Nutricia, and ALK Abelló.

PEER REVIEW

The peer review history for this article is available at https://www.webofscience.com/api/gateway/wos/peer‐review/10.1111/pai.70192.

Protudjer JLP. The hidden price of food allergy: Understanding the social and financial burdens on families. Pediatr Allergy Immunol. 2025;36:e70192. doi: 10.1111/pai.70192