title: Estimating the economic burden of food-induced allergic reactions and anaphylaxis in the United States.
abstract: 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.
authors.affiliation: School of Pharmacy, Virginia Commonwealth University, Richmond, VA 23298-0533, USA.
authors.forename: Dipen A
authors.initials: DA
authors.lastname: Patel
authors.forename: David A
authors.initials: DA
authors.lastname: Holdford
authors.forename: Eric
authors.initials: E
authors.lastname: Edwards
authors.forename: Norman V
authors.initials: NV
authors.lastname: Carroll
mesh_terms: D000707:Anaphylaxis / Q000191:economics* / Q000453:epidemiology*; D005512:Food Hypersensitivity / Q000191:economics* / Q000453:epidemiology*; D017048:Health Care Costs; D006801:Humans; D014481:United States / Q000453:epidemiology