When life gets complicated: Food allergy, food insecurity, mental health, and substance use disorder

Patients seen in allergy-immunology clinics may experience a myriad of socioeconomic problems that intersect with both social determinants of health and allergic and immunologic disease. Although not a primary focus of allergist-immunologist management, all clinicians must be ready and able to express compassion and understanding for patients who struggle with conditions that affect their adherence to recommended therapies. Food allergy in particular can have complex interactions with food insecurity, mental health, and substance use disorder because each of these comorbidities affects allergen avoidance and risk of anaphylaxis. This review outlines key considerations and provides resources to connect patients with needed assistance. Approaching patients who have challenging psychosocial and socioeconomic comorbidities with a willingness to help connect them with needed resources-from primary care providers, counselors, and allergen-aware food banks-can have a positive impact on health and well-being.