INTRODUCTION
Food insecurity (FI) represents a growing public health concern, particularly among vulnerable pediatric populations. Defined by the U.S. Department of Agriculture as reduced quality, variety, or desirability of diet—or a reduced or disrupted food intake—FI can have significant health consequences for children. Among those with chronic health conditions, such as food allergies (FA), the risk of FI may be further compounded by dietary restrictions and the high cost of allergen-free foods. This study aimed to examine the prevalence of FI in a pediatric allergy/immunology clinic and explore the intersection of FA status, race and ethnicity, and geographic access to food. Additionally, the project sought to create a structured workflow to screen for FI using the validated Hunger Vital Sign questionnaire, ultimately linking at-risk families to essential resources and social support. The high participation rate and significant findings underscore the urgency of addressing FI in clinical allergy settings.
FI PREVALENCE IN PEDIATRIC ALLERGY CLINICS
The study revealed a striking 23% prevalence of food insecurity among patients in the pediatric allergy/immunology clinic. This rate is notably higher than national averages, signaling a disproportionate burden within this specialized population. Such a high prevalence suggests that food insecurity is a hidden yet pervasive issue among children dealing with chronic allergic conditions. The data emphasize the need for routine screening and intervention strategies in allergy clinics, where clinicians may not typically assess food access but could play a critical role in identifying and supporting at-risk families.
DEMOGRAPHIC FACTORS AND FI ASSOCIATIONS
The analysis identified significant associations between FI status and specific demographic factors such as race, ethnicity, and age. These results reflect broader social disparities and suggest that systemic inequities are mirrored within the pediatric allergy community. Although FA status and geographic distance to grocery stores were not significantly related to FI, the prominence of racial and ethnic disparities underscores the importance of culturally sensitive interventions. Recognizing these demographic patterns can help inform more equitable and inclusive care practices in clinical settings.
SCREENING TOOLS AND CLINICAL WORKFLOWS
This study introduced the use of the validated two-question Hunger Vital Sign tool for efficient FI screening in the allergy/immunology clinic. Its simplicity, ease of use in both English and Spanish, and high response rate (89.1%) demonstrate its feasibility in fast-paced clinical environments. Additionally, the introduction of a third question for FA patients—assessing access to allergen-free foods—offered important nuance to standard screening. The integration of screening into clinic workflows, paired with resource referral and social work access, represents a replicable model for other specialty care settings.
ROLE OF FA STATUS IN FI
Contrary to initial concerns, the study found no significant association between physician-diagnosed food allergy and food insecurity status. This surprising result may suggest that while FA presents challenges in food selection and cost, it may not independently increase the likelihood of overall FI. However, qualitative differences—such as the stress of accessing safe foods—may still exist and require further study. Incorporating more sensitive or condition-specific FI measures in future research could help clarify the unique burden that food allergy places on families.
IMPLICATIONS FOR CLINICAL PRACTICE AND POLICY
The findings serve as a critical call to action for clinicians, researchers, and policy-makers. Pediatric allergists are uniquely positioned to identify FI and intervene early. Implementing standardized screening protocols and ensuring linkage to support resources can address the unmet needs of food-insecure families. Furthermore, data from studies like this can inform broader healthcare policies aimed at reducing disparities and improving access to specialty care. Ultimately, this research lays the groundwork for developing tailored programs to support children with chronic conditions and specialized dietary needs.
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