Prevalence of food allergy differs by race, ethnicity, income
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Key takeaways:
- Black children had the highest rate of peanut allergy, and Asian children had the highest rate of tree nut allergy.
- Households earning more than $150,000 a year had the lowest rates of convincing food allergy.
Racial, ethnic and socioeconomic differences in the prevalence of food allergies are evident in ED visits related to food allergies and epinephrine autoinjector use, according to a study published in JAMA Network Open.
Further research into socioeconomic factors and environmental exposures may better explain the causes of these allergies and inform targeted management and interventions to reduce their burden, Ruchi S. Gupta, MD, MPH, professor of pediatrics and medicine at Northwestern Feinberg School of Medicine, and colleagues wrote.
“Food allergies are not frequently talked about impacting racial and ethnic minorities. It’s not on the radar. But we now know it does impact them more, and it’s important to improve awareness,” Gupta, who also is director of the Center for Food Allergy and Asthma Research, said in a press release.
“It is also critical to improve access to diagnosis and treatments for food allergy. It is an exciting time with new treatments, and making sure they reach racial and ethnic minorities who have higher rates of food allergy is essential,” she continued.
Study design, results
The cross-sectional survey study polled 51,819 households with 78,851 individuals (51.1% female) in the United States including 38,408 children (mean age, 8.7 years) and 40,443 adults (mean age, 46.8 years) via telephone or online between Oct. 9, 2015, and Sept. 18, 2016.
Participants included 3.7% Asian, 12% Black, 17.4% Hispanic, 62.2% white and 4.7% of more than one race or other race, which the researchers called comparable to the general population in the United States.
The researchers asked participants about their experiences with allergies to cow’s milk, hen’s egg, peanut, tree nuts, soy, wheat, sesame, fin fish and shellfish, including whether allergies were convincing or confirmed by a physician.
Convincing allergies were defined as self-reported or parent-reported allergies corroborated by a history of symptoms related to an IgE-mediated food allergy.
Physician-confirmed allergies included convincing food allergies as well as a physician diagnosis obtained via oral food challenge, skin prick testing or specific IgE testing.
Also, the researchers characterized allergies as severe if the stringently defined symptoms that were reported involved two or more organ systems, such as the skin and/or oral mucosa, respiratory, gastrointestinal or cardiovascular systems.
Across all age groups, 10.1% had a convincing food allergy and 5% had a physician-confirmed food allergy, with increases as children got older, plateaus during adulthood and decreases in the geriatric years in all race and ethnicity categories.
By race and ethnicity, 10.5% (95% CI, 9.1%-12%) of Asian participants, 10.6% (9.8%-11.5%) of Black participants, 10.6% (95% CI, 9.7%-11.5%) of Hispanic participants and 9.5% (95% CI, 9.2%-9.9%) of white participants had a convincing food allergy.
Pediatric rates of convincing food allergies included a high of 8.9% (95% CI, 7.6%-10.3%) among Black children and a low of 6.5% (95% CI, 5.1%-8.2%) for Asian children.
Also, 3% (95% CI, 2.4%-3.8%) of Black children had a convincing peanut allergy, which the researchers called the highest among all races and ethnicities. Black children also led in egg (1.6%; 95% CI, 1%-2.7%) and fin fish (0.9%; 95% CI, 0.6%-1.5%) allergies. At 2% (95% CI, 1.2%-3.2%), Asian children had the highest rate of tree nut allergy.
White participants had the lowest overall rate of convincing food allergy at 10.1% (95% CI, 9.7%-10.6%) among adults. Asian participants had the highest rates of peanut (2.9%; 95% CI, 2%-4.2%) and shellfish (3.8%; 95% CI, 3%-4.9%) allergies among adults.
Black participants had the highest prevalence of tree nut allergies at 1.6% (95% CI, 1.2%-2.1%), and Hispanic participants had the highest prevalence of hen’s egg (1.2%; 95% CI, 0.8%-1.8%) and fin fish (1.5%; 95% CI, 1.1%-1.9%) allergies, also among adults.
Convincing food allergies were most prevalent among households earning between $50,000 and $99,999 per year at 10.7% (95% CI, 10.2%-11.3%) and least prevalent among households earning $150,000 or more a year at 8.3% (95% CI, 7.4%-9.2%).
Further, 50.6% (95% CI, 46.1%-55.1%) of Black participants had multiple convincing food allergies, which was the highest rate among measured races and ethnicities. Black participants also had the highest rate of at least one severe convincing food allergy reaction at 55.8% (95% CI, 51.7%-59.8%).
Other rates of severe convincing food allergy reactions included 51.3% (95% CI, 47%-55.5%) for Hispanic participants, 46.9% (95% CI, 39.8%-54.1%) for Asian participants and 47.8% (95% CI, 45.9%-49.7%) for white participants.
Rates of ED visits related to food allergy in the past year included 15.5% (95% CI, 12.3%-19.5%) for Hispanic participants, 13.5% (95% CI, 9.7%-18.4%) for Black participants, which were higher than the other racial and ethnic categories.
Similarly, Hispanic and Black participants had the highest rates of lifetime ED visits related to food allergy, including 47.7% (95% CI, 43.5%-52%) for Hispanic participants and 45.4% (95% CI, 40.8%-50.1%) for Black participants.
Rates of epinephrine autoinjector use included 23.6% (95% CI, 20.3%-27.2%) for Black participants, 24.6% (95% CI, 21.7%-27.9%) for Hispanic participants, 22.6% (95% CI, 17.7%-28%) for Asian participants, 20.9% (95% CI, 19.5%-24.4%) for white participants and 19.4% (95% CI, 14.7%-25.3%) for more than one or other race, but the researchers did not consider these differences significant.
Rates of current epinephrine autoinjector prescriptions included 30.4% (95% CI, 27.1%-34.1%) for Hispanic participants, 28% (95% CI, 22.4%-34.4%) for Asian participants, 26.7% (95% CI, 23.3%-30.5%) for Black participants, 26% (95% CI, 24.4%-27.6%) for white participants and 23.6% (95% CI, 18.5%-29.7%) for more than one or other race. The researchers did not consider these differences significant either.
Households with lower annual incomes had greater prevalence of patient reports of severe food allergy reaction histories, the researchers continued, but they did not consider these differences statistically significant.
Differences in rates of current epinephrine prescriptions based on household income were significantly different, the researchers said, with the households with the lowest incomes most reporting current prescriptions.
Participants with annual household incomes less than $25,000 were most likely to report a visit to the ED related to a food allergy in the previous year (16.2%; 95% CI, 12.9%-20%) and in their lifetime (44.3%; 95% CI, 40.6%-48.2%).
The researchers did not note any significant differences in severity of food allergy based on type of insurance, except patients with private insurance had a 22.2% (95% CI, 17.3%-28%) rate of epinephrine autoinjector prescriptions, and patients with public insurance had the highest rates of ED visits related to food allergy at 16.7% (95% CI, 9%-28.8%).
Adjusted odds ratios for at least one convincing food allergy compared with white participants included 1.21 (95% CI, 1.02-1.43) for Asian participants, 1.15 (95% CI, 1.03-1.29) for Black participants, 1.17 (95% CI, 1.04-1.3) for Hispanic participants and 1.46 (95% CI, 1.23-1.71) for participants with more than one or other race.
Conclusions, next steps
Based on these findings, the researchers concluded that the burden of food allergy disproportionately falls on individuals of races and ethnicities other than white and on individuals with lower household incomes.
Access to care remains a challenge as well, the researchers said, prompting many families to simply try to avoid these foods.
“We now know that racial and ethnic minorities as well as underserved populations often do not get to an allergist for diagnosis,” Gupta, who is a member of the Healio Asthma/Allergy Peer Perspective Board, said.
“They have the symptoms of food allergy but the access to get to a specialist has been challenging, and the fact that there were no treatments led them to just try and avoid the food,” she said.
The researchers called for additional research into sociocultural and economic characteristics and their associations with food allergy outcomes, which may inform effective interventions for improving food allergy management.
“Our goal is to see these numbers start to come down in the next 30 to 40 years,” Gupta said.
Reference:
- Food allergy rate is highest among Hispanic, Black and Asian individuals. https://news.northwestern.edu/stories/2023/06/food-allergy-is-lowest-among-households-earning-more-than-150000-a-year/. Published June 15, 2023. Accessed June 21, 2023.