Food insecurity screening in the allergy/immunology clinic: A work group report of the AAAAI adverse reactions to foods committee

Food insecurity (FI) is defined by the US Department of Agriculture as reduced quality, variety, or desirability of a diet or reduced or disrupted intake of food. There is concern that children with food allergy (FA) may be more likely to be food insecure. The purpose of this project was to investigate the prevalence of FI in the pediatric allergy/immunology population and determine the impact of FA status, race and ethnicity, and geographic food access. An additional goal was to develop a workflow for FI screening in the allergy/immunology clinic setting. Parents of patients were given the validated 2-question Hunger Vital Sign questionnaire in English or Spanish. Those with physician-diagnosed FA were asked a third question about access to allergen-free foods. Families who screened positive for FI received a list of local resources and access to social work assistance. The response rate was 89.1%, with 179 completed surveys. Twenty-three percent of patients screened positive for FI. There was a significant association between race and ethnicity, age, and FI status. FA status and distance from the nearest grocery store were not significantly associated with FI. This study adds to the mounting evidence highlighting the burden of FI in the allergy/immunology population and serves as a call to action for practicing allergists. Efficient FI screening can be accomplished using widely available validated tools. Continued efforts will enable the development of targeted resources to meet this pressing need, with tailored solutions for those on specialized diets.