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August 28, 2018

What’s the Cost of a Severe Peanut Allergy?

Artemis Health

It’s that time of year again—the time of year when moms and dads around the country send their little angels back to school. Some of you are celebrating, and some of you are wistfully thinking about how fast they grow up. And there’s a good chance some of you are looking for lunch ideas that don’t include peanut butter sandwiches.

Severe peanut allergies affect anywhere from 0.6% to 1.4% of the population, depending on which study you believe. If it seems to you like peanut allergies are more common than they used to be, you’re right. Self-reported peanut allergies doubled in children from 1997 to 2002 according to research published in The Lancet. Nut-free classrooms are popping up in schools to keep kids with allergies from experiencing itching, swelling, respiratory distress, anaphylaxis, cardiac arrest, or even death.

The easiest solution for schools is to ban peanut butter from school snacks and lunches. While for some this seems like an imposition, for children with allergies it’s a question of safety and health. Many websites even offer sample letters that teachers, principals and parents can use to explain the reason for a peanut butter ban.

So what does this mean for employers, who are often the payers when it comes to allergy testing, treatment and emergency medications? We decided to take a look at our sample data to see how peanut allergies are affecting overall benefits spend.

The methodology.

We looked at three different scenarios related to food allergies:

  • The cost of an anaphylactic episode
  • The cost of allergy testing and immunotherapy
  • The cost of the emergency allergy drug epinephrine (EpiPen and generics)

By looking at these three data points, we’re able to calculate the cost of an allergy “episode”—the cost of an attack, follow up testing and treatment, and a common prescription that allergy sufferers need.

The results.

Ok, so let’s imagine it’s little Olivia’s first day of kindergarten. She doesn’t know she has a severe peanut allergy, so she happily swaps her Oreos for her new friend’s peanut butter cookies. Her throat begins to itch, she’s having trouble breathing, and hives pop up on her skin. A teacher notices her distress, and the school nurse begins treatment for anaphylaxis. Olivia’s parents pick her up as soon as possible and take her to the nearest emergency clinic for further treatment.

What does this cost for Olivia’s parents and the payer on her plan?

This is a look at overall claims for a diagnosis of anaphylactic shock, but to our surprise, the cost varies based on the type of allergy:

Anaphylactic shock due to peanuts is the highest cost for employers at $756, though an anaphylactic reaction due to eggs is much less expensive for all parties. There’s a logical reason for this—peanut allergies can cause a more severe allergic reaction that requires emergency medical attention, whereas other foods may cause a minor reaction.

Ok, so now that little Olivia has been treated for anaphylaxis related to peanuts, what’s next for her care? She’ll likely visit an allergist, confirm the diagnosis, and seek longer term treatment. Our next step in the analysis is to determine the cost of allergy testing and immunotherapy.

On average, employers will pay $428 for testing and $67 for immunotherapy, while employees will kick in $64 and $8 for these services.

So Olivia goes back to kindergarten, and she has her confirmed diagnosis. The school has banned peanuts in her classroom, so she should be safe now. But what if Olivia is exposed to peanuts again? What if she eats a peanut butter cup without understanding the consequences, or a kid from another class brings a PB&J to lunch? Her parents want to keep her safe and avoid another anaphylactic episode. She needs an epinephrine prescription, the generic name for the EpiPen.

This drug can stop allergic reactions and help restore normal breathing during anaphylactic shock, and the delivery mechanism (a spring-loaded needle for injection into the thigh muscle) makes it accessible for either the allergy sufferer or a bystander to use it quickly and safely. Mylan, the maker of the EpiPen, infamously hiked prices and paid undisclosed rebates to PBMs to discourage competition. A two-pack of the lifesaving drug went from $90 to $600 for patients.

Prices for EpiPen have dropped back down due to public outrage, lawsuits and even racketeering charges, and a generic competitor is on the horizon. But you can still see the high cost of this drug for employers:

Let’s do some quick math to get a final look at what little Olivia’s peanut allergy would cost her plan’s payer.

  • The cost of an anaphylactic episode = $765
  • The cost of allergy testing and immunotherapy = $495
  • The cost of the emergency allergy drug epinephrine (EpiPen and similar) = $601

Total cost for employer = $1,861

So now that you know how allergy episodes may be affecting your benefits spend, let’s tackle the other looming question—how do you pack your kid’s school lunch to keep their friends and classmates safe?

There are many commercially available non-nut butters out there to replace the P in a PB&J. Allergy sufferers suggest tahini, cookie butter, soynut butter, coconut butter...and they’re all allowed past the door of a nut-free classroom. If you’re a DIY type parent or want to skip the sugar, you’ll probably want to mix up a batch of homemade sunflower butter.

This recipe comes from popular health and food blogger The Detoxinista ( and gets great reviews.

Homemade Sunflower Seed Butter

How to make homemade sunflower butter, with no added oil and just a hint of low-glycemic coconut sugar.





  1. Preheat the oven to 350F and spread the sunflower seeds into a thin layer on a large rimmed baking sheet. Toast until the seeds start to turn lightly golden and have a nutty aroma, about 20 to 25 minutes. Stir the seeds around every 10 minutes or so while they're toasting to prevent burning.
  2. Put the toasted seeds into a food processor fitted with an "S" blade and start processing them. Just like making almond butter, you'll need a bit of patience during this part. First, the sunflower seeds will be ground into a fine meal, and in about 5 to 6 more minutes, it should start to form a sticky ball.
  3. After the ball stage, blend for another 5 minutes or so for the butter to reach a creamy consistency. Once it’s smooth, you can add the coconut sugar and salt, to taste, and keep processing for a couple more minutes to incorporate it evenly.
  4. Transfer the butter to a glass jar with an airtight lid and store it in the fridge for up to a month.
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