Allergen-free food access lower among Black vs. white children

Black children with food allergies had less access to allergen-free foods compared with white children, based primarily on socioeconomic status and education, according to a study.

Amaziah T. Coleman, MD, from the division of allergy and immunology at Children’s National Hospital, and colleagues wrote that non-Hispanic Black children have had the sharpest increase in food allergy prevalence over the past 20 years.

Additionally, Black children with food allergy tend to have poorer clinical outcomes than white children, and white children experiencing food-induced anaphylaxis are more likely to receive epinephrine prior to ED arrival.

“Barriers to health care and food access may be contributing factors for the racial and geographic differences in food allergy burden among children in the U.S. with food allergy,” Coleman and colleagues wrote in the study, published in The Journal of Allergy and Clinical Immunology: In Practice. “Food insecurity in households of children with food allergy has additionally been reported to increase the burden of meeting basic nutritional needs.”

To determine the differences in allergen-free food access among Black and white children with food allergy, the researchers assessed 336 children (median age, 6.5 years) from the prospective cohort FORWARD study, of whom 70.2% were white and 29.8% were Black.

Although sex and number of food allergies were similar among the children in the cohort, Black children were older (8 vs. 5.6 years; P < .001). The caregivers of Black children had lower annual household income (less than $50,000, 49% vs. 4.2%) and education level (less than a bachelor’s degree, 55% vs. 8.9%; P < .001 for both) than caregivers of white children. Food allergy knowledge was evaluated based on a 16-point survey, and scores were higher in the cohort of white children (11.8 vs. 8.8; P < .001).

Initial analysis showed that white children were more likely to have access to allergen-free food compared with Black children (88.1% vs. 59%; P < .001) and caregivers of white children were more likely to purchase allergen-free foods online compared with caregivers of Black children (35.2% vs. 12%).

After adjusting for sex, age, multiple food allergies, household income, parental education, food allergy knowledge score and recruitment site, the OR for race decreased but with borderline significance (OR = 2.4; 95% CI, 0.9-6.6).

Strong predictors for access to allergen-free food included online access (OR = 2.5; 95% CI, 0.9-7.5), current milk allergy (OR = 4.9; CI, 1.7-13.8) and current age older than 5 years (OR = 2.3; 95% CI, 1.1-4.8).

Socioeconomic status correlated with access, including annual household income of $50,000 to $100,000 (OR = 2.9; 95% CI, 0.9-9.3) or greater than $100,000 (OR = 2.5; 95% CI, 0.9-7.2) compared with less than $50,000. Participants with a bachelor’s degree were also more likely to have access to allergen-free foods than those with a high school degree (OR = 2.9; 95% CI, 1.1-7.8).

“Online food purchases were found to be significantly associated with greater access to allergen-free foods, suggesting that education of caregivers regarding online food purchasing may be an important intervention for future investigation,” Coleman and colleagues concluded.