Is Food Allergy a Disqualification for Military Service?
As food allergies and food-induced anaphylaxis become more prevalent across all age groups, these medical conditions will render an increasing fraction of young Americans ineligible to join the U.S. Armed Forces, while a growing number of service members will develop adult-onset food allergies while in uniform.
Food allergies affect 1 in 13 children, treatment for severe food allergy reactions is up nearly 400 percent in the past decade, and a 2017 study found that nearly half of adults with food allergies developed at least one food allergy during adulthood. As food allergies and food-induced anaphylaxis become more prevalent across all age groups, these medical conditions will render an increasing fraction of young Americans ineligible to join the U.S. Armed Forces, while a growing number of service members will develop adult-onset food allergies while in uniform.
In 2017, the Military Allergy and Immunology Assembly (MAIA) of the American Academy of Allergy, Asthma & Immunology (AAAAI) established a working group to evaluate and summarize the food allergy policies of the service branches that make up the U.S. Armed Forces. The resulting paper, published last month in the Journal of Allergy and Clinical Immunology, provides guidance so that allergists within and outside the military can provide accurate advice to individuals with food allergies who are seeking to join, or remain in, the Armed Services.
Military service can place members in remote locations with limited food and healthcare options. For this reason, a history of systemic allergic reaction to food or food additives is a disqualifying medical condition for individuals seeking to join the military. Sensitization – that is, elevated food-specific IgE, but no clinical history of reaction symptoms when consuming the food – is not a disqualifying condition. The different service branches use different terms to define disqualifying food allergies. The U.S. Army definition is broader, referring to a “reliable history of a moderate to severe reaction to common foods, spices, or food additives,” whereas the Air Force, Navy and Marine Corps definitions make specific references to a history of anaphylaxis.
An individual excluded from the Armed Services on the basis of food allergy history can request a waiver, which may be granted depending on the results of an appointment with an allergist. A waiver is unlikely if the allergist recommends that the prospective recruit carry an epinephrine auto-injector or if either the allergist or the recruit is reluctant to complete an oral food challenge. Also unlikely to receive a waiver are prospective recruits with eosinophilic esophagitis.
In contrast, if the allergist conducts an oral food challenge and the prospective recruit passes the challenge, the recruit is likely to receive a waiver; his or her allergy would be considered resolved, even with a past history of severe reactions. Prospective recruits with oral allergy syndrome may also qualify for a waiver.
There are also differences across the service branches in the retention policies applied to members who develop food allergies while serving. The Army regulations related to retention are not specific to food allergies, and the medical evaluation to assess fitness for duty following a food allergy reaction is conducted on a case-by-case basis.
Members of the Air Force automatically receive a medical evaluation if they experience an allergic reaction to one of the top eight food allergens. In the Air Force, Navy and Marine Corps, being prescribed an epinephrine auto-injector does not typically result in being discharged for medical reasons, but a history of anaphylaxis can adversely affect eligibility for specific assignments and specialized training. In all branches, repeated or severe reactions can lead to a medical evaluation that may find the service member not fit for duty or unable to deploy.
By summarizing military instructions, policies and regulations regarding IgE-mediated food allergy, this working group report can help civilian allergists provide all of the information required for a waiver request if a patient seeks to join the Armed Services. Military allergists will also find use for the working group report in the assessment of service members who develop food allergies while in the Armed Forces. FARE advises prospective recruits who are seeking a waiver to consult with their allergist as a first step.