Estimating the economic burden of food-induced allergic reactions and anaphylaxis in the United States

doi:10.1016/j.jaci.2011.03.013

Journal of Allergy and Clinical Immunology

Volume 128, Issue 1, July 2011, Pages 110-115.e5

https://doi.org/10.1016/j.jaci.2011.03.013 Get rights and content

Background

Food allergy is reported to affect 4% to 6% of children and 1% to 2% of adults in the United States. Every year, allergic reactions result in visits to physicians, emergency departments, and hospitals. However, the economic burden of food-induced allergic reactions is unknown.

Objective

We sought to estimate the direct medical costs and indirect costs of food-induced allergic reactions and anaphylaxis in the United States.

Methods

Costs were estimated with a bottom-up approach from a societal perspective: the average cost of illness per patient was calculated and multiplied by reported prevalence estimates. Patients with an inpatient admission, emergency department admission, office-based physician visit, or outpatient visit for a food-induced allergic reaction were identified from a list of federally administered 2006 and 2007 databases by using International Classification of Diseases, ninth revision, codes. Indirect costs were quantified by estimating lost productivity in terms of lost earnings caused by absenteeism and mortality of patients or caregivers. Sensitivity analyses were conducted to measure the robustness of the estimates.

Results

For 2007, direct medical costs were $225 million, and indirect costs were $115 million. Office visits accounted for 52.5% of costs, and the remainder was split between emergency visits (20%), inpatient hospitalizations (11.8%), outpatient visits (3.9%), ambulance runs (3%), and epinephrine devices (8.7%). Simulations from probabilistic sensitivity analyses suggested mean direct medical costs were $307 million and indirect costs were $203 million.

Conclusions

The economic burden of allergic reactions caused by food and anaphylaxis was an estimated half a billion dollars in 2007. Ambulatory visits accounted for more than half of the costs.

Section snippets

Study design

This was a retrospective analysis of 2006 and 2007 data (the latest available) from published literature and 4 national databases maintained by federal agencies. A societal perspective was used as an approach because it has been found to be more comprehensive in assessing the costs attributable to a disease.¹⁶ Economic costs were estimated by using a prevalence-based approach, which involves measuring the costs of an illness in one period, usually a year, regardless of the date of disease onset.

Results

In 2006 and 2007, an estimated 1.4 million medical encounters caused by FAA occurred in the United States. Table III provides a description of the demographic and clinical characteristics of these patients in the 4 different datasets. Weighted counts were reported since they are representative of the national estimates.

Discussion

This is the first study to provide estimates of the economic burden of FAA in the United States. In our analysis of more than 35,000 patients with food-induced allergic reactions, estimated direct medical costs were $225 million and indirect costs were $115 million for 2007. Given irregularities in reporting and diagnosing food allergy, these values might be an underestimation. Simulations from probabilistic sensitivity analyses generated mean direct medical costs of $307 million and indirect

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Allergy has been recognized as a full specialty in France since 2017 and interest in the field of anaphylaxis has been increasing over the last decade reflecting in the attempt of gathering deeper knowledge on pathomechanism and understanding of potential risk factors in order to provide quality of care of patients, and prevent new episodes and avoidable deaths. Tacking patients and populations at risk is key to strengthen health policies, preventive and public health actions in the national, regional and international levels. For this reason, we here propose a snapshot of ongoing health policies, advocacy actions and research perspectives of anaphylaxis in France in order to tailor optimised actions in the coming years of the French Allergy Society, through the Anaphylaxis working group, in collaboration with the WHO Montpellier Collaborating Centre. We here propose an action plan based on national advances, alignment with international perspectives and promotion of research. The French Allergy Society should move forward with the organization of the ANAFIL network and optimisation of actions to bridge the unmet needs in the field of anaphylaxis. Multiple problems still exist in the management of patients with anaphylaxis: some are medical with a paucity of trained allergists and health professionals, delay in referrals, incorrect labelling of patients, create care channels from emergencies, improve staff training in schools, raise awareness among public authorities, set up a register of the most serious cases, deaths at any age, distribute recommendations to emergency physicians. Many are social and ethical such as the ranging from lack of awareness, poor food labelling, failing supplies of functioning auto-injectable adrenaline injectors as well as unwillingness of patients to carry and use them. Certainly, an improvement on the current situation is needed. We strongly believe that this document can provide the clues to tracked and collaborative actions in the years to come to improve the quality of care of patients suffering from anaphylaxis in France.
L’allergie est reconnue comme une spécialité en France depuis 2017 et l’intérêt pour le domaine de l’anaphylaxie a augmenté au cours de la dernière décennie, reflétant la tentative d’approfondir les connaissances sur le mécanisme pathologique et la compréhension des facteurs de risque potentiels afin de fournir des soins de qualité aux patients et prévenir de nouveaux épisodes et des décès évitables. Le suivi des patients et des populations à risque est essentiel pour renforcer les politiques de santé, les actions de prévention et de santé publique aux niveaux national, régional et international. Pour cette raison, nous proposons ici un état des lieux des politiques de santé en cours, des actions de plaidoyer et des perspectives de recherche sur l’anaphylaxie en France afin d’adapter les actions optimisées dans les années à venir de la Société française d’allergie, à travers le groupe de travail Anaphylaxie, en collaboration avec Centre Collaborateur de l’OMS de Montpellier. Nous proposons ici un plan d’action basé sur les avancées nationales, l’alignement sur les perspectives internationales et la valorisation de la recherche. La Société française d’allergie doit aller de l’avant avec l’organisation du réseau ANAFIL et l’optimisation des actions pour combler les besoins non satisfaits dans le domaine de l’anaphylaxie. De multiples problèmes subsistent dans la prise en charge des patients atteints d’anaphylaxie: certains sont médicaux avec une pénurie d’allergologues et de professionnels de santé formés, retard dans les orientations, étiquetage erroné des patients, création de filières de soins à partir des urgences, amélioration de la formation du personnel dans les écoles, sensibilisation du public autorités, établir un registre des cas les plus graves, des décès à tout âge, diffuser des recommandations aux urgentistes. Beaucoup sont d’ordre social et éthique, comme l’absence de connaissance, le mauvais étiquetage des aliments, l’approvisionnement défaillant d’injecteurs d’adrénaline ainsi que la réticence des patients à les transporter et à les utiliser. Certes, une amélioration de la situation actuelle est nécessaire. Nous sommes convaincus que ce document peut fournir des pistes d’actions suivies et concertées dans les années à venir pour améliorer la qualité de la prise en charge des patients souffrant d’anaphylaxie en France.
Acute At-Home Management of Anaphylaxis: 911: What Is the Emergency?
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The appropriate at-home management of anaphylaxis begins with patient education on recognition and treatment, especially when and how to use epinephrine. Delayed administration of epinephrine as well as having severe symptoms and needing multiple doses of epinephrine to treat symptoms are risk factors for biphasic anaphylaxis. The successful implementation of at-home management of anaphylaxis requires appropriate patient selection and an algorithmic approach that recommends activation of emergency medical services (EMS) when the patient does not adequately respond to at-home administration of epinephrine or there are extenuating patient-related circumstances. Fortunately, approximately 98% of anaphylactic episodes respond to 2 or fewer doses of epinephrine, the standard prescription used for epinephrine autoinjectors; fatal anaphylaxis is very rare, as low as 0.002 deaths/million person-years; and biphasic reactions are uncommon (∼5%), and only extremely rarely lethal. Thus, most common concerns leading to recommended EMS activation and emergency department visits after epinephrine administration are generally unsubstantiated. Furthermore, emergency department visits do not always lead to better treatment and drive health care costs higher. Open communications with patients and families regarding risks and benefits of at-home management and observation versus EMS activation and emergency department evaluation after epinephrine administration for anaphylaxis are essential. However, we believe the data indicate that it is time to reconsider the often used and taught approach that recommends EMS activation whenever epinephrine is used.
Economic burden of food allergy in Canada: Estimating costs and identifying determinants
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Citation Excerpt :
Our methodology is similar to most previous cost-of-illness studies, which developed estimates through surveying affected individuals or families.2,4,6-9,11,13,14 Although administrative databases generally allow for inclusion of larger numbers of affected individuals and validation of healthcare utilization,3,5,10 they are limited by potential diagnostic inaccuracies and do not allow for inclusion of indirect costs. Although several studies provide estimates that include only healthcare3,5,7,10 or out-of-pocket8,9,11,14 costs, there are few that provide comprehensive direct-cost estimates.2
Limited data exist on the economic burden of food allergy (FA).
To assess FA-related direct (healthcare and out-of-pocket) and indirect (lost productivity) costs and their determinants in Canadian children and adults self-reporting FA.
FA-individuals self-reporting a convincing history or physician diagnosis were recruited through FA registries, an anaphylaxis registry, and advocacy associations, and electronically surveyed regarding FA-related healthcare use, out-of-pocket expenditures, and time lost from paid and unpaid labor. Direct and indirect costs (2020 Canadian dollars [CAD]) were stratified on severe reaction vs mild, moderate or no reaction, and children vs adults; multivariate regressions assessed the association between costs and sociodemographic and disease characteristics.
Between May 2018 and July 2019, 2692 eligible individuals responded (2189 convincing history and 503 physician diagnosis only); 1020 experienced a severe reaction; 1752 were children. Per FA-individual, annual healthcare, out-of-pocket, and indirect costs were $1267, $2136, and $7950. Those with a severe reaction had higher healthcare and out-of-pocket costs than those with mild, moderate or no reaction. FA-children vs FA-adults had higher healthcare and out-of-pocket costs, and lower indirect costs. Multivariate results showed that lower age, a severe reaction ever, multiple FAs, and fair or poor general health were associated with higher healthcare and out-of-pocket costs. Higher age, lower household education and income, and fair or poor general health were associated with higher indirect costs.
The economic burden of FA in Canada is substantial, particularly for those with a severe reaction ever, multiple FAs, and fair or poor general health. It is crucial that those most adversely affected are allocated appropriate resources to support disease management.
Allergic manifestations in autoimmune gastrointestinal disorders
2022, Autoimmunity Reviews
Allergic disorders target a young population, are increasing in both incidence and prevalence and are associated with significant disease burden. They result from the complex interplay between (epi)genetic and environmental factors, resulting in a Th2 inflammatory process targeting the epithelium of the respiratory tract (allergic rhinitis and asthma), skin (atopic dermatitis), and gastrointestinal tract (food allergy). Although the exact pathogenic mechanisms remain elusive, an altered immune system response in the gut is increasingly recognized as a relevant step. Allergic and gastrointestinal autoimmune disorders share several epidemiological, pathogenic and risk factors and several treatment modalities. Here we revise the current literature and show that allergic disorders are highly prevalent in gastrointestinal autoimmune diseases, including celiac disease, inflammatory bowel disease, autoimmune pancreatitis, and autoimmune cholangiopathies. No data are available for some autoimmune diseases, such as autoimmune gastritis and autoimmune enteropathy. To ensure the comprehensive care of patients with autoimmune gastrointestinal disorders, along with disease-specific factors, the presence of allergic disorders should be evaluated and treated when present, possibly targeting shared molecular pathways. Future studies are needed to define the exact pathogenic mechanisms underpinning the association between allergic and autoimmune diseases of the gastrointestinal tract.
Adoption of 2016 EpiPen administration instructions by pediatric emergency department staff
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The Cost-Effectiveness of Preschool Peanut Oral Immunotherapy in the Real-World Setting
2021, Journal of Allergy and Clinical Immunology: In Practice
Across North America, 1.4% to 4.5% of children and families live with peanut allergy (PA). Preschool peanut oral immunotherapy (POIT) has been shown to be safe and effective in the real-world setting.
Evaluate the cost effectiveness of preschool POIT in North America.
Markov cohort analyses and microsimulation was used to evaluate simulated preschool children with PA over an 80-year time horizon. Models incorporated the natural history of PA, comparing children treated with preschool POIT with those not receiving immunotherapy. Costs were expressed in U.S. and Canadian dollars.
A preschool POIT strategy was associated with cost savings while improving quality-adjusted life-years (QALY), dominating a nonimmunotherapy approach. Over the model horizon, when all costs (and effectiveness) of PA were included from a societal perspective, a POIT versus a non-POIT approach cost $82,514 (18.51 QALY) versus $84,367 (17.75 QALY) in the United States, and $40,111 (18.83 QALY) versus $53,848 (18.26 QALY) in Canada. In microsimulations, systemic reactions to POIT were less frequent than anaphylaxis from accidental exposure without POIT (United States: 3.59, SD 3.49 vs 19.53, SD 11.71; Canada: 3.63, SD 3.54 vs 4.56, SD 3.30), epinephrine use was reduced with POIT (United States: 5.85, SD 5.73 vs 9.76, SD 5.85; Canada: 0.34, SD 0.36 vs 0.53, SD 0.38), and fatalities were rare but lower in the POIT strategy (United States: 0.00005, SD 0.0071 vs 0.00015, SD 0.012; Canada: 0.00005, SD 0.0071 vs 0.00009, SD 0.0095).
Preschool POIT in a real-world setting improved health and economic outcomes in the United States and Canada.

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: Supported in part by the Food Allergy and Anaphylaxis Network.

: Disclosure of potential conflict of interest: D. A. Patel has received research support from the Food Allergy and Anaphylaxis Network (FAAN). D. A. Holdford is an investor in Johnson & Johnson and has received research support from the FAAN. E. Edwards is the Chief Science Officer of and has stock ownership in Intelliject, Inc. N. V. Carroll has declared that he has no conflict of interest.

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Food, drug, insect sting allergy, and anaphylaxisEstimating the economic burden of food-induced allergic reactions and anaphylaxis in the United States

Background

Objective

Methods

Results

Conclusions

Section snippets

Study design

Results

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Emerg Med

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Curr Probl Pediatr Adolesc Health Care

J Allergy Clin Immunol

Value Health

J Allergy Clin Immunol

Ann Epidemiol

Am J Prev Med

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Anaphylaxis and emergency treatment

Pediatrics

Food, drug, insect sting allergy, and anaphylaxis
Estimating the economic burden of food-induced allergic reactions and anaphylaxis in the United States