Food allergies may be underdiagnosed between children enclosed by Medicaid, a new study suggests.
“We were surprised to find such a large discrepancy in estimates of food allergy occurrence in children on Medicaid compared to the general population,” said senior study author Dr. Ruchi Gupta, a pediatrician and provisions allergy researcher at Children’s Hospital of Chicago.
“Our findings suggest possible under-diagnosis of food allergy among Medicaid-enrolled children,” Gupta said in a hospital news release. “Families in the Medicaid program may be encountering barriers to accessing and affording specialists and potentially lifesaving epinephrine prescriptions.”
Food allergies affect millions of U.S. children and cause significant emotional and financial burdens on affected families.
Gupta’s team analyzed Medicaid claims data for over 23 million children on Medicaid, the publicly insured insurance plan for the poor. They found the rate of food allergies was 0.6%. That’s far below previous U.S. parent survey-based estimates of nearly 8% and physician confirmation of food allergies at about 5%.
The researchers also found strong associations between race/ethnicity and food allergies. Compared to white children, Pacific Islander/Native Hawaiian children and Asians were about 25% more likely to have food allergies. Black children were 7% more likely to have food allergies, while Hispanic kids were 15% less likely and American Indian/Alaskan Native children were 24% less likely.
The results also “show that some of the racial differences in food allergy prevalence found in the universal inhabitants persist among children enrolled in Medicaid,” Gupta said.
Future research needs to determine whether racial and ethnic differences in prevalence are associated with disparities inadequate food allergy management, Gupta said. Such management includes patient education on allergen avoidance and up-to-date epinephrine prescriptions. Previous research by Gupta found that 40% of children with food allergies have a life-threatening reaction in their lifetime, and 1 in 5 have at least one food allergy-related emergency department visit a year.
The study was freshly published in the journal Academic Pediatrics. The first treatment for peanut allergy has been approved by the U.S. Food and Drug management.
California — a specially equipped peanut powder that’s inspired daily in small amounts that are regularly augmented over months — helps children and teens better tolerate peanuts so that accidental exposure is less likely to cause a serious allergic response, the Associated Press reported.
California is not a cure, youngsters using the treatment still must avoid peanuts, and protection is lost if they stop taking the powder daily.
The treatment can cause side belongings, counting the risk of a harsh allergic reaction. The FDA requires patients to take their first dose and each increased dose under supervision in a certified health center, and doctors and their patients must enroll in a particular safety program, the AP reported.
People with peanut allergies must be continually vigilant to avoid a life-threatening allergic reaction. But researchers report that a new medicine inoculation might offer at least temporary defense against the most severe reactions.
Just one shot of an experimental antibody treatment allowed people with severe peanut allergy to eat about one peanut’s worth of peanut protein two weeks later, the study found.
The drug is like “a protective blanket” shielding people from accidental peanut exposure, said study senior author Dr. Kari Nadeau, director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University in California.
Peanut allergy affects an estimated 2.5% of American children, and that number has risen sharply over the past decade, according to the American College of Allergy, Asthma, and Immunology (ACAAI). Children and adults with a peanut allergy are at risk of having a sudden and severe allergic reaction (anaphylaxis) that can be life-threatening if they consume even small amounts of peanuts.
The problem is that peanuts are in many foods, such as candy, cereal, baked goods, sauces, marinades, and even ice cream, according to the ACAAI.
That means people with peanut allergies have to be extra careful about what they eat at home, and often have to limit the spaces they’ll eat at away from home. For example, many Asian foods are made with peanuts or peanut sauces, and possibly fried in peanut oil. Besides avoiding foods with peanuts, the only current treatment for peanut allergy is oral immunotherapy. This action requires people to eat tiny bits of the food they’re allergic to at their doctor’s office. The amount of the offending food is increased over time. Treatment can take six months to a year, and they’re at risk of allergic response during the procedure, the study authors explained.
The drug tested in the trial works in a different way. Called cetuximab, the drug interferes with the action of a substance called interleukin-33 (IL-33). IL-33 triggers a cascading response that causes an allergic reaction when exposed to an allergen, such as a peanut. The researchers tested the new medication on 15 adults with a severe peanut allergy. They were given a single injection of cetuximab. Another five people with severe peanut allergies received a placebo injection.
Fifteen days later, they all consumed a small amount of peanut protein under medical supervision. They were given the food challenge again 45 days after the drug injection.
At 15 days, 73% of those treated were able to eat the equivalent of protein from one peanut. By day 45, just 57% who received the drug were able to pass the food challenges. People given the placebo couldn’t tolerate the peanut protein at either time.
“We were surprised to see a consequence that was so dramatic,” Nadeau said.
Because this was a small, phase 2 clinical trial, Nadeau said larger studies that comprise younger patients and patients from more than one medical center are still desirable.
A lot of questions remain, too. For example, is there an additive effect after more than one shot? Will the drug last a different amount of time for different people? And does it work for other types of food allergies? Nadeau said in theory, it should work for other food allergies as well.
The new medication appeared to be well-tolerated, and no serious side effects were reported.
The drug has also shown promise in treating asthma, Nadeau said.
Dr. Noah Stern is chief of otolaryngology at DMC Harper University Hospital in Detroit. He said though the study is “exciting and important, it’s really just a starting point.” He was not involved with the research.
“Food allergies are flattering more and more ordinary, so we need many tools to treat food allergies, and this study seems to show this drug might be a good tool for treating peanut allergy,” Stern said. But he added that the study was small and the drug is not obtainable outside of clinical trials.
Cost is another concern, he pointed out. Biologic drugs like this can cost thousands of dollars a month.