Socioeconomic disparities affect prevalence of specific food allergies
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Key takeaways:
- Children with peanut allergies had significantly lower Area Deprivation Index scores.
- Children from households with incomes greater than $150,000 were less likely to have shellfish allergies.
SAN ANTONIO — Socioeconomic deprivation may play a role in the development of allergies to certain foods, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
“We already know the prevalence of certain food allergies varies among different racial and ethnic groups,” Anandu Dileep, DO, an internist in the division of allergy/immunology at Rush University Medical Center, said during his presentation. “So, the goal of our study was to see if these racial disparities could be explained by socioeconomic factors.”
The researchers began with data from the longitudinal, observational and multicenter Food Allergy Outcomes Related to White and African American Racial Differences (FORWARD) Study, which involved non-Hispanic white, non-Hispanic Black and Hispanic children with food allergy.
Also, the researchers gathered data on the annual household income and highest education levels of the caregivers of these children as well as the Area Deprivation Index (ADI) as a proxy for the local socioeconomic conditions in each child’s household.
“ADI characterizes a child’s neighborhood based on several socioeconomic determinants including income, education, employment and housing quality,” Dileep said. “Living in a higher ADI neighborhood is associated with greater socioeconomic disadvantage.”
Using multiple logistic regression analyses, the researchers assessed associations between each food allergen and ADI adjusted for recruitment site, age, gender, household income, highest level of parental education and race and ethnicity.
“Mean ADI was significantly higher for children without peanut, tree nut and sesame allergies when compared to children who do have those allergies,” Dileep said.
Among the 392 children with peanut allergy, mean ADI was 35 (standard deviation [SD], 26.7), whereas children who did not have peanut allergy had a mean ADI of 41 (SD, 27.2; P < .004).
Mean ADIs also included 32.9 (SD, 26.1) for the 328 children with tree nut allergy and 41.9 (SD, 27.3) for those who did not have a tree nut allergy (P < .0001), as well as 27.9 (SD, 25.1) for the 93 children with a sesame allergy and 39.3 (SD, 27.1) for those who did not have a sesame allergy (P = .0001).
Compared with families with annual household incomes less than $50,000, odds ratios for developing a peanut allergy included 1.96 (95% CI, 1.14-3.36) for households with incomes between $50,000 and $150,000 and 2.31 (95% CI, 1.19-4.47) for households with incomes greater than $150,000.
Similarly, odds ratios for developing a tree nut allergy included 1.39 (95% CI, 0.81-2.37) for households with annual incomes between $50,000 and $150,000 and 2.09 (95% CI, 1.08-4.05) for those with incomes greater than $150,000 compared with families with incomes less than $50,000.
Children with shellfish, soy or wheat allergy also had significantly higher mean ADI than children who did not have these allergies, Dileep continued.
“In contrast, children from households with income greater than $150,000 were less likely to have shellfish, soy and wheat allergies,” Dileep said.
The researchers did not report any statistically significant association between allergies to finned fish, milk or egg and ADI or annual household income; however, they did suggest some explanations for the associations that they did find.
“Black children have significantly higher odds of allergy to shellfish, and our data show that shellfish allergy is associated with socioeconomic deprivation and low annual household income,” Dileep said.
Increased exposure to cockroach and dust mite allergens can mediate cross-sensitization in the development of shellfish allergy, he continued.
“Living in an urban environment with higher ADI can predispose children to experiencing poor housing conditions, which can lead to more cockroach and mite exposure,” Dileep said.
Noting the association between peanut and tree nut allergies and lower ADI, the researchers further said that households with higher incomes were more likely to have these allergies.
“A potential explanation for this is that families with higher incomes might have a more varied diet in their household,” Dileep said. “This can then lead to more exposure to foods through skin at early stages of life.”
Increased exposures to foods that are highly allergenic early in life may be related to risks for allergy to peanuts and tree nuts among these children, the researchers suggested.
Considering these findings, Dileep said, the role of socioeconomic deprivation in food allergy development should not be ignored. Families with higher incomes are more likely to have self-injectable epinephrine, he continued, putting children from families with lower incomes at disproportionately increased risk for fatal allergic reactions.
Due to costs, Dileep also said that families with low incomes were less likely to purchase products that were allergen-friendly and buy products with allergen precautionary labeling instead. Programs that better assist these families are needed, the researchers said.
“As we learn more about food allergy, we learn more about the best ways to manage it,” he said. “However, socioeconomic deprivation should not be an obstacle to accomplishing appropriate medical treatment for food allergic children.”
Perspective
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Andrea Pappalardo, MD, FAAAAI, FACAAI
We know that social determinants of health matter in the development and control of allergic disease. However, the direct linkages of how are not as clear. This study is trying to link where certain groups may be predisposed to distinct food allergens and how that relates to social determinants of health.
We see in our clinic and in research how urban children and adults, especially non-Hispanic Blacks, are more likely to have shellfish allergy. This study attempts to connect an increase in exposure to indoor allergens in urban children as a mediating factor for the eventual development of shellfish allergy. Specifically, the researchers hypothesize that this is through cross-sensitization to cockroach and dust mite allergens.
In my experience, the children and adults with allergies that I treat in the urban Chicago setting are often plagued with environmental exposures outside their control, and that directly influences their allergic disease development and ability to manage each of these atopic disorders effectively.
We need to first recognize how environmental exposures throughout life do indeed influence the development and severity of allergic diseases. Then, we need to screen for these factors in our patients using a screening tool for social determinants of health. We need to serve as an advocate and provide practical resources such as tenant organizations that help facilitate enforcement of pest control and other items in rented housing facilities.
Further, we need to better understand how these exposures directly affect, if they do, the development of specific food allergens. Next, does mitigation help? If so, at what life stage is it imperative to intervene to prevent this atopic march from occurring? We also need to further investigate the reasons why certain allergens were found in lower and higher ADI households and the impact this has on families over time.
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Dileep A, et al. Abstract 135. Presented at: AAAAI Annual Meeting; Feb. 24-27, 2023; San Antonio.
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