Study Finds Higher Prevalence of Food Allergies Among People of Color Compared to White Individuals

Food allergies are shown to be most prevalent among communities of color and in people at lower socioeconomic levels, a new study finds.

Food allergies are incredibly common. According to the Asthma and Allergy Foundation of America, as of 2021 about 20 million people in the United States had food allergies.

The new research reached 51,819 households—a total of 78, 851 people—in the U.S. from October 2015 to September 2016 by way of online and telephone surveys, with the aim of looking at how the presence of food allergies in the nation might break down demographically.

The team found that Asian, Black, and Hispanic people were most likely to report having food allergies compared to their White peers, while food allergies were evidenced less in households at the highest income brackets.

When looking at the data, lead study author Jialing Jiang, research project manager at the Center for Food Allergy & Asthma Research (CFAAR) at Northwestern Feinberg School of Medicine, said the team suspected that some racial and ethnic groups “might experience more food allergy burden,” complementing other research from the U.S., United Kingdom, and Australia.

That being said, this new research offered a more comprehensive picture.

“Past studies did not allow for generalizability due to limitations in sample size, study design, and groups compared,” Jian said. “When we administered our U.S. population-based survey, we did not expect that White individuals would have the lowest rate of food allergy compared to other races and ethnicities considering the abundance of food allergy research on White populations.”

In a snapshot of some of the findings, non-Hispanic White people across all ages had the lowest rate of self or parent-reported food allergies at 9.5%, in contrast to Asian participants at 10.5%, Hispanic participants at 10.6%, and non-Hispanic Black participants at also at 10.6%.

The study also showed that non-Hispanic Black respondents were the group most likely to report allergies to multiple kinds of foods, coming out to 50.6% of respondents. Asian and non-Hispanic White people showed the lowest rates of severe food allergy reactions compared to other groups, at 46.9% and 47.8%, respectively.

When asked what might account for these ethnic and racial demographic differences, Jiang said it is currently “unclear” why Asian, Black, and Hispanic people seem to experience more food allergies than their White peers.

Hypotheses include differences in diet, cultural practices and norms, environmental factors, and genetics.

Jian’s co-author, Ruchi Gupta, MD, MPH, the Mary Ann & J Milburn Smith Senior Scientist in Child Health Research and Director of CFAAR, a professor of pediatrics and medicine at Northwestern Feinberg School of Medicine and a clinical attending physician at the Ann & Robert H. Lurie Children’s Hospital of Chicago, agreed with those points adding that common foods one might have as a key part of their diet, the age of when certain foods were introduced, and the environment are all potential factors.

According to Ahila Subramanian, MD MPH FAAAAI FACAAI, of the Food Allergy Center of Excellence Cleveland Clinic, “The exact cause of food allergy is still unclear but we know there are multiple factors that can impact the development of a food allergy.”

She explained race and socioeconomic status, having another allergic disease, infant feeding practices, delaying solid food in diet, and less exposure to microbes—such as in urban vs. farm dwellings—to all potentially impact a person’s susceptibility to food allergies.

Subramanian, who is unaffiliated with this research, said that the underlying potential for allergies to be tied to genetics and epigenetics is a possibility as well.

Julie Wang, MD, pediatric allergist-immunologist, professor of pediatrics at the Icahn School of Medicine at Mount Sinai, and a clinician and clinical researcher at the Jaffe Food Allergy Institute, added that the big question mark that looms over why one person might develop food allergies compared to another means more research needs to be conducted to “understand how sociocultural and economic factors impact food allergy prevalence, management, and outcomes.”

It’s important we get a better understanding of this to outline clear strategies for addressing entrenched disparities, Wang told Health.

When it came to socioeconomic status, the study showed that households with an annual income greater than $150,000 were at the lowest levels of prevalence of self or parent-reported food allergies, at 8.3%.

Subramanian explained that when looking at this, it is crucial to understand that socioeconomic status and race “are closely linked.”

“Having financial access to afford a regular supply of ‘safe’ foods is crucial for the successful management of food allergy and reducing the incidence of food allergy reactions,” Subramanian said.

Jiang said financial resources can have a wide-reaching domino effect on how people can manage their allergies. For example, having a current epinephrine auto-injector (EAI) prescription was more common among people with higher household incomes and the use of EAIs was higher in those with higher household incomes.

“Emergency department visits for food allergy reactions in the last year and in a lifetime were highest for those in the lowest household income bracket, possibly due to barriers in food allergy management,” she said. “While it is not in the scope of our study, previous studies have suggested that financial access to more resources allows better access to allergen-free foods to manage food allergy.”

Jiang said that food allergies prevalent among the diverse groups surveyed included allergies to peanuts, shellfish, milk, and tree nuts, which is in keeping with trends we see in the U.S. at large.

That being said, the data showed some racial and ethnic groups experience certain allergies differently.

For instance, peanut allergies are more prevalent among Asians. Shellfish allergies are the least common among the White population.

Subramanian explained that this survey goes along with other research out there that shows a “slightly higher prevalence of certain food allergies by race.”

It’s important to note that “these findings have not been consistent across studies,” she said.

Subramanian noted cultural dietary norms also seem to play a key role here.

“For example, allergy to finned fish is seen more often in countries with higher consumption of fish such as Australia, Spain, and Portugal compared to the United States,” she said.

“Another example can be seen in Greece where the incidence of peanut allergy is very low compared to the overall global incidence of peanut allergy. Interestingly peanut is not a common ingredient in Greek cuisine.”

According to Subramanian, once a food allergy is identified for a person, the treatment plan involves “avoiding the culprit allergen and preparing the patient” in case they have a reaction.

Understanding an individual’s socioeconomic background is important to provide an effective treatment plan for managing the allergy.

“Financial means impact the ability to treat a food allergy reaction via access to medications such as the epinephrine autoinjector, as well the ability to provide a nutritionally balanced diet to the patient via alternative foods, without the culprit food, that is often more expensive,” Subramanian said.

She said this research is important in highlighting the health disparity in food allergy outcomes by race and socioeconomic background. It opens the door to understanding, but more research needs to be done.

Looking back on the new study, Jiang said it was limited in that they were unable to analyze “subpopulations” and categorized some groups into one category for the purposes of analysis. Future research “should consider the further cultural differences and diversity within racial and ethnic groups experiencing food allergies and explore their unique food allergy burden.”

“It would be great to follow families over time from the actual initial diagnosis and better understand environmental factors, family history, genetics, microbiome, etc.,” she said. “We need a better full picture.”