Food Allergy Burden Higher in Black, Hispanic, and Asian Americans

A nationally representative sample of the U.S. population found that Black, Hispanic, and Asian Americans of all ages carry the highest burden of food allergies, researchers reported.

Survey data collected from more than 50,000 households revealed "convincing" self- or parent-reported food allergies in 10.6% of Black and Hispanic individuals, 10.5% of Asian people, and 9.5% of white people, according to Ruchi Gupta, MD, MPH, of Northwestern University Feinberg School of Medicine in Chicago, and colleagues.

Income also appeared to be a factor, such that households with an annual income over $150,000 had the lowest food allergy prevalence (8.3%) while households with an income from $50,000 to $99,999 had the highest (10.7%).

Food allergy outcomes -- including severe reactions, multiple food allergies, and visits to the emergency department (ED) -- along with the specific types of allergy "systematically varied across individuals of different racial and ethnic backgrounds," Gupta and coauthors wrote in JAMA Network Open.

Among people with food allergies, the lowest rates of severe allergies were reported in Asian (46.9%) and white (47.8%) respondents; Black individuals reported the highest rates of multiple food allergies (50.6%); and Hispanic and Black individuals had the highest rates of past-year ED visits (15.5% and 13.5%, respectively) or lifetime ED visits (47.7% and 45.4%).

"Food allergies are not frequently talked about impacting racial and ethnic communities," Gupta said in a press release. "It's not on the radar. But we now know it does impact them more, and it's important to improve awareness."

Tree nut allergy was highest among Asian children, while rates of egg and fin fish allergies were highest in Black children. Among adults, peanut and shellfish allergies were highest in Asian respondents, tree nut allergy was highest in Black individuals, and Hispanic adults had the highest egg and fin fish allergies.

In their discussion, the researchers noted that seafood allergy appeared to be more common among Asian and Hispanic groups, and pointed to systemic racism as a potential culprit.

"It is unclear what factors are associated with seafood allergy, but previous literature has hypothesized that it may be mediated by differential sensitization to household-level environmental exposures, such as dust mites or cockroaches," wrote Gupta and coauthors. "These exposures may be present as a result of environmental injustices latently established through historically racially, ethnically, and socioeconomically biased policies."

But all of the environmental factors that contribute to food allergy are not fully understood, according to Corinne Keet, MD, PhD, of the University of North Carolina at Chapel Hill. And this makes it difficult to say what is responsible for the differing food allergy prevalence rates between groups, she said.

"One thing we do know that influences the rate of food allergy is early introduction of food allergens by mouth, which reduces the rate," said Keet, who was not involved in the study. "It is certainly possible that this could be related to disparities. Other factors, like pollution or other dietary factors could also be at play."

L. Keoki Williams, MD, MPH, of the Henry Ford Health System in Detroit, suggested that a follow-up to the current study could tease out differences among subgroups of the populations included in the study.

"For example, we have seen from other studies big differences in asthma prevalence between Latinos identifying as Puerto Rican and Latinos identifying as Mexican," said Williams, who also was not involved in the research. "Rather than lumping these groups together, there may be additional important within-group differences in food allergy."

The cross-sectional study from Gupta and colleagues surveyed 51,819 households from October 2015 to September 2016 online and via telephone to assess the prevalence of food allergies across different racial, ethnic, and socioeconomic groups in the U.S.

Researchers used "stringent symptom criteria" in order to identify respondents with a convincing food allergy (with or without diagnosis from their physician) rather than just those with food intolerance.

Overall, 38,408 children and 40,443 adults were included in the study (62.2% white, 17% Hispanic, 12% Black, 3.7% Asian, and 4.7% "other" or multiracial).

In the kids, Black children had the highest food allergy prevalence rates (8.9%), followed by Hispanic children (8%) and white children (7%), while Asian kids had the lowest (6.5%). Among adults, these rates were 11.2%, 11.6%, 10.1%, and 11.4%, respectively.

The researchers also examined insurance status and epinephrine autoinjector use/prescriptions as well, but found no significant differences.

Limitations to the study included that small sample sizes led to multiple groups being included under the "other" or multiracial category (including Native Hawaiians or other Pacific Islanders, and Native American or Alaskan people). The survey was also only conducted in English and Spanish, which could have resulted in an underrepresentation of Asian or other groups.

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