Clinical Context

Food allergy affects approximately 8% of children in the US, and the prevalence of food allergy among children has generally been increasing for the past 2 decades. However, the increase in food allergy cases has not been the same in all racial/ethnic groups. A previous study by Mahdavinia and colleagues, published in the March-April 2017 issue of the Journal of Allergy and Clinical Immunology: In Practice, used a retrospective cohort design to assess the relationship between race/ethnicity and food allergy among children in 2 urban tertiary care centers in the United States.^[1]

A total of 817 children were included in the study: 35% were African American and 12% were Hispanic; 53% of patients were White. Compared with White patients, Black children had higher rates of eczema and asthma, and they were also more likely to have an allergy to wheat, soy, corn, fish, and shellfish. Hispanic children had higher rates of eczema compared with White children, but the prevalence of asthma was similar in these 2 groups. Hispanic children had higher rates of allergy to corn, fish, and shellfish compared with White children. Finally, Black and Hispanic children had a shorter duration of follow-up with an allergy specialist and experienced higher rates of anaphylaxis and emergency department visits.

The current study expands on this prior research of disparities in food allergy by including adults and social determinants of health in its analysis.

Study Synopsis and Perspective

TOPLINE:

The prevalence of food allergies and rates of specific types vary by race, ethnicity, and income, according to research published online June 14 in JAMA Network Open.^[2]

METHODOLOGY:

• A nationally representative survey of 51,819 households was conducted in 2015 and 2016.
• Researchers grouped participants by race (including Asian, Black, and White), ethnicity (Hispanic and non-Hispanic), and socioeconomic status and estimated the prevalence of food allergies in each category.

TAKEAWAY:

• Non-Hispanic White individuals had the lowest rate of self-reported or parent-reported food allergies (9.5%), compared with Asian (10.5%), Hispanic (10.6%), and non-Hispanic Black (10.6%) individuals.
• Among kids, Black children had the highest rate of food allergies (8.9%), whereas Asian children had the lowest rate (6.5%).
• Asian children had the highest rates of tree nut allergies (2.0%), whereas Black children had the highest rates of allergies to peanuts (3.0%), eggs (1.6%), and fin fish (0.9%).
• By income, the prevalence of food allergies was lowest among households earning more than $150,000 per year (8.3%).

IN PRACTICE:

“Additional targeted, educational interventions may address disparities in [food allergy] outcomes and improve targeted [food allergy] management,” the researchers say.

STUDY DETAILS:

Ruchi S. Gupta, MD, MPH, founding director of the Center for Food Allergy and Asthma Research at the Northwestern University Feinberg School of Medicine in Chicago, Illinois, is the study’s corresponding author. The research was supported by a grant from the National Institute of Allergy and Infectious Disease and Denise and Dave Bunning.

LIMITATIONS:

The study relied on self- and parent-reported data, and the researchers did not evaluate subpopulations within racial or ethnic groups. Sample sizes were limited for individuals who identified as multiracial, Native Hawaiian, Pacific Islander, American Indian, or Alaskan Native.

DISCLOSURES:

The authors have received grants or fees from nonprofit organizations, foundations, biopharmaceutical companies, and government and academic centers. Dr Gupta has an ownership interest in Yobee Care, a company that markets scalp care products.

Implications for the healthcare team

• In a previous study of pediatric patients with food allergy, Black children had higher rates of eczema and asthma compared with White children, and Black children were also more likely to have an allergy to wheat, soy, corn, fish, and shellfish. Hispanic children had higher rates of eczema compared with White children, but the prevalence of asthma was similar in these 2 groups. Hispanic children had higher rates of allergy to corn, fish, and shellfish compared with White children. Finally, Black and Hispanic children had a shorter duration of follow-up with an allergy specialist and experienced higher rates of anaphylaxis and emergency department visits.
• In the current study, the prevalence of food allergy was highest among Black, Hispanic, and Asian participants, with lower rates among White participants. Food allergy was less common among participants with a household income of $150,000/year or more, but health insurance status was not associated with any of the food allergy prevalence outcomes.
• When providing clinical guidance and patient education, the healthcare team should be aware that racial and ethnic minority groups in the US have higher rates of food allergy, and households with high income levels have lower rates of food allergy.

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