Do Allergists Consider Food Insecurity in the Clinic?

Food insecurity is a prominent issue made increasingly more complex and exponentially worse by economic effects of the pandemic. The American Academy of Allergy, Asthma & Immunology (AAAAI) Food Insecurity Work Group surveyed pediatric allergy specialists and found that 70% didn't know whether their patients faced food insecurity, that there was limited understanding of food insecurity resources for the allergic population, and that screening is not being implemented as part of routine practice.

In this exclusive MedPage Today video, Jodi Shroba, APRN, CPNP, the chair of the Work Group and lead author of the report, who is a nurse practitioner at Children's Mercy Hospital in Kansas City, Missouri, discusses the survey and the screening toolkit the team put together in response to the results.

Following is a transcript of her remarks:

I'm Jodi Shroba. I'm a nurse practitioner at Children's Mercy Hospital in Kansas City. I am in the Division of Allergy, Immunology, Pulmonary, and Sleep Medicine. I currently am the food allergy program coordinator for our hospital. And today I'm going to be talking about a work group report that we had done for the American Academy of Allergy, Asthma & Immunology or AAAAI.

And so this was a large project that we had done. There were about 15 authors on it. And we were concerned with the pandemic about food insecurity.

Now, obviously food insecurity isn't a new problem. We all know that. But the pandemic really highlighted what a great problem it was. And so we wanted to look at are we assessing food insecurity in the allergy clinic? And historically food insecurity screening has been a social determinant of health and primarily done in primary care. However, it is kind of starting to get a movement of getting into the specialty clinics, and especially with a lot of diseases where food is your medicine, it really is important that allergists are looking at food insecurity.

So we did send out a survey to a random sample of AAAAI members. Unfortunately we had a low survey result response rate. We have a few theories -- maybe it was just the timing of the survey; there could have been a lot of survey burnout. It was COVID, so a lot of people were doing emails and maybe were just kind of tired or maybe they just didn't know much about food insecurity screening.

So of the results we got, only about 20-25% were actually screening for food insecurity in their clinic; 70-75% actually had mentioned that they weren't screening and they weren't even having conversations with their families about are they food insecure.

And so when we kind of got these results and we saw such a low response rate, we really kind of then switched from research gear to educational process. And so we then created kind of a toolkit for allergists to start screening in their practice. And the number one thing we heard was that they don't know the resources that are available. They don't know where to start. They just don't know how to start climbing that mountain. So we did offer the varying screening tools that are out there.

The most common one used is the Hunger Vital Signs. That's the one we currently use. It's a very short two-question response. And if they screen positive, then obviously you want to give resources. And they do recommend only doing that once a year. However, if you feel like the situation of the family has changed, then obviously you would want to do it more often than that.

And then we started talking about some of the government programs, such as WIC [Special Supplemental Nutrition Program for Women, Infants, and Children], SNAP [Supplemental Nutrition Assistance Program], the Emergency Food Program, and summer meal programs.

And some of the weaknesses of those programs -- while they are still good, and they are very important -- we kind of wanted to highlight how with WIC and SNAP they may not give enough substitutions for those that are avoiding food. And so that's where that food allergy and food insecurity go hand in hand of they may be having a problem obtaining the food because of money, but they may be having trouble obtaining the food because of the cost of the food. And so a family may not screen as food insecure for the other members of the family, but the one with the allergies, it's very expensive.

And so we talked about those resources. We talked about how you could get involved in your community by working with local pantries, working with just organizations in your area that could help with those social determinants of health, and then talking about just having resources at your hospital.

And so we were published in January of 2022 in the Journal of Allergy and Clinical Immunology: In Practice, and we hope it's well received. We hope that it will start more of a conversation about food insecurity and really bring it more to light and not make it such an uncomfortable conversation.

Any time that you have to bring up something like that, nobody wants to admit that they're having trouble. So we hope that this at least will give an allergist the tools to start screening in their practice.

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