Background

Food affordability has become a mainstream political crisis in recent months after the Chancellor of the Exchequer proposed price caps on bread, milk and eggs, only to be met with criticisms from supermarkets and the Bank of England.¹ The issue reflects a deeper and longer-running reality in the UK: food prices have risen by nearly 39% since 2020, and the proportion of households experiencing food insecurity has grown from 7% to 11% in just two years.² For millions of families, the weekly food shop has become a source of genuine hardship.

But for families managing a child’s food allergy, the affordability crisis cuts deeper. My recently published scoping review in Nutrition Reviews, conducted with support from Dr Kate Maslin, set out to map what we currently know about how food insecurity affects the management of children living with food allergy.³

Why food insecurity matters in this population

Food insecurity, defined as the inadequate physical, social, and economic access to sufficient, safe and nutritious food, is rising in high-income countries.4 Post-pandemic estimates suggest that around one in five children in both the UK and the US are now affected.^{5, 6} The consequences for food insecurity in child health include numerous concerns: poorer diet quality, growth, behaviour and quality of life.⁷

Children with food allergies carry an additional and often underappreciated financial burden. Allergen-free food is estimated to cost two to four times more than standard equivalents, contributing to a reported 14% increase in household grocery expenditure.^{8, 9} For families managing multiple or severe allergies to staple foods such as wheat or cow’s milk, this cost compounds further. Add to this the wider burden of food allergy (i.e. the loss of productivity, medical costs, the psychosocial toll), and it becomes clear that food insecurity is not just a background risk factor, but a potential driver of poorer outcomes.⁹

What the review found

Following the JBI Scoping Review Methodology, we included 56 reports (representing 31 unique data sets) published across electronic databases and grey literature sources. The evidence base has expanded sharply since 2020, likely in response to the economic disruptions of the COVID-19 pandemic, but it remains almost entirely from North America (predominantly the USA and Canada), with only one UK-based report identified.³

Six concepts emerged from qualitative analysis: prevalence of food insecurity; food allergy-related quality of life; the influence of social determinants of health; risk of adverse events; healthcare and social interventions; and multisector recommendations.³

The prevalence of food insecurity among children with food allergy ranged widely across studies: from 5% to nearly 70%, reflecting differences in screening tools used, populations studied, and settings. Despite this variability, children with food allergy were consistently more likely to experience food insecurity than their peers without food allergy. COVID-19 worsened both prevalence and severity. Concerningly, a survey of allergy clinicians found that almost three-quarters were unaware whether their patients were experiencing food insecurity, and only 15% routinely screened for it.³

Food insecurity was associated with significantly worse food allergy-related quality of life, greater anxiety, lower self-efficacy, higher perceived risk of accidental ingestion, and reduced access to adrenaline auto-injectors. The intersecting role of social determinants was clear: racial minority groups, particularly Black and Hispanic children in the US, and those from lower income households, faced disproportionately higher rates of food insecurity and worse outcomes. Few interventions were identified and no clinical guidelines or policies specifically addressing food insecurity in children with food allergy were found.³

What this means for practice

The review is primarily a signposting exercise, but the clinical implications are already actionable. Firstly, awareness: consider asking families about food affordability and access – not just allergen avoidance – as part of your routine assessment for all patients.

Second, know your local resources: very few food banks consistently stock allergen-free products, and some families with food allergies are opting out of free school meals. Signposting to services that cater for food allergies, advocating locally where they don’t, and developing culturally appropriate resources on ways to save on food shopping and cooking, are within our scope of practice.

Third, and perhaps most importantly, recognise that this is an area where dietitians can lead. The primary authors of research in this field are predominantly allergists and paediatricians; food and nutrition specialists are significantly underrepresented, as reflected in the lack of nutrition-related outcomes in the evidence. We have a professional responsibility and unique skill set to drive research, advocacy and service development that addresses the intersection of food allergy and food insecurity in the UK, from a truly holistic, bio-psycho-socio-economic lens.

^{References: 1. Armstrong A, Parker G, Fleming S. Rachel Reeves drops push for food price cap after retail backlash. Financial Times. Accessed online: www.ft.com/content/636b9473-0488-4d72-98ae-55ff008d7221?syn-25a6b1a6=1 (May 2026). 2. UK Parliament (2026). The impact of food inflation on the cost of living. Accessed online: https://commonslibrary.parliament.uk/research-briefings/cdp-2026-0004/ (May 2026). 3. Atwal K, Maslin K (2026). Impact of Food Insecurity on the Management of Children With Food Allergy: A Scoping Review. Nutr Reviews.; nuag066. 4. FAO. Coming to Terms with Terminology: Food Security, Nutrition Security, Food Security and Nutrition, Food and Nutrition Security [Internet]. 2022. Available from: www.fao.org/fileadmin/templates/cfs/Docs1112/CFS39Docs/CFS_FSN_Terminology_16_October_2012.pdf 5. Gundersen C, et al. (2021). The Impact of Coronavirus on Food Insecurity. Applied Eco Perspectives Pol.; 43(1): 153–161. 6. Pereira A, Handa S, Holmqvist G (2017). Prevalence and Correlates of Food Insecurity among Children across the Globe. Innocenti Working Papers.; inwopa900. 7. Hartline-Grafton H, Hassink SG (2021). Food Insecurity and Health: Practices and Policies to Address Food Insecurity among Children. Acad Pediatr.; 21(2): 205–210. 8. Food Standards Agency (2023). Estimating financial cost to individuals with a food hypersensitivity: Executive summary. Accessed online: www.food.gov.uk/research/estimating-financial-cost-to-individuals-with-a-food-hypersensitivity-executive-summary (May 2026). 9. Bilaver LA, et al. (2019). Economic burden of food allergy: A systematic review. Ann Allergy Asthma Immunol.; 122(4): 373-380.e1.}