Food Allergy: Surprising Patterns, Rising Costs

With the holidays coming up, many parents of children with food allergies are acutely conscious of this growing national health problem. Such parents are always aware of the possibility that their child will accidentally consume an ingredient at a holiday dinner or party that can bring on an aggressive, even life-threatening reaction. Increased awareness of this condition has generated a powerful hunger for information about food allergy and its most dangerous consequence, the severe, potentially fatal reaction called anaphylaxis.

In August, we published an article presenting some of our preliminary findings on food allergy and promised a more detailed white paper on the subject. That white paper is now available, presenting new data on many aspects of food allergy and anaphylactic food reaction. Like our previous article, it draws on our database of billions of privately billed healthcare claims, but it delves further into the spread of food allergy across the country, how specific food allergies intersect with age and gender, and the medical services and costs associated with food allergy.

One finding is particularly noteworthy: From 2007 to 2016, the number of laboratory services associated with diagnoses of anaphylactic food reaction increased 871%, and the percentage of billed charges for those services increased even more—5390%. Those figures are an indication of the growth of both food allergy and its costs.

Geographic Spread

As detailed in the new white paper, in many states, claim lines with food allergy diagnoses represented an increasing share of all medical claim lines from 2009 to 2016. (“Claim lines” are the individual procedures or services listed on an insurance claim.) The association between particular states and food allergy has changed over time. In 2009, the 5 states with the highest percentage of claim lines with food allergy diagnoses compared to all medical claim lines were (in order from highest) New York, Georgia, Colorado, North Dakota and Ohio. The top 5 states in 2016 were (in order from highest) North Carolina, North Dakota, New Jersey, Washington, DC, and Connecticut. Only North Dakota stayed in the top 5 in both years.

Age and Gender

Food allergy is often thought of as a childhood condition, but it can continue into adulthood and begin in adulthood. We found that different food allergies were associated with different age groups. In the period 2007-2016, the age group 6-10 years accounted for 28% of claim lines with peanut allergy diagnoses, but only 9% of claim lines with food additive allergy diagnoses. On the other hand, the age group 51-60 years accounted for 1% of claim lines with peanut allergy diagnoses, but 17% of claim lines with food additive allergy diagnoses.

It has been reported that being male is a risk factor for food allergy. But our data suggest that the risk may depend on the age of the patient and the specific allergy. In the period 2007-2016, claim lines with food allergy diagnoses were associated with boys more than girls from birth through age 18. For individuals older than 18 years, however, food allergy claim lines were associated with women more than men. In this period, males predominated over females in the percentage of claim lines associated with peanut, egg and milk product allergy diagnoses, but females predominated over males with respect to seafood and food additive allergy diagnoses.

Services and Costs

An anaphylactic food reaction is generally regarded as a medical emergency. But, when we analyzed claim lines with a diagnosis of anaphylactic food reaction in the period 2007-2016, we found that 70% of claim lines were associated with an office as the place of service, and only 2% specifically with an emergency room. Even so, the office setting was associated with only 51% of providers’ billed charges for anaphylactic food reaction, suggesting that the office was less costly than the other places of service.

We found milk product allergy to be the food allergy with the highest average costs and services per patient in 2016. This is probably because milk product allergy is associated with the youngest children, poses risks to their nutrition and growth and often requires prescription-based formulas. Among patients diagnosed with anaphylactic food reactions in 2016, the highest average costs per patient were for anaphylactic reaction to fish. This may be because this type of reaction is relatively uncommon and fish products may be found in odd places, such as barbecue sauce and Worcestershire sauce. As a result, extensive testing may be needed to find the food triggering the reaction.

For a full discussion of these and other findings, see our white paper. We hope that it brings new information to parents of children with food allergy, to adults with food allergy and to researchers and policy makers working to address this public health issue.

The white paper has been made possible in part with the generous funding of Food Allergy Research & Education (FARE).

About the Author

Robin Gelburd, JD, is the president of FAIR Health, a national, independent, nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 24 billion claim records contributed by payors and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. FAIR Health also holds separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts.