Disproportionate Impact of Food Allergies on People of Color and Lower-Income Individuals: Findings from a National Study

 Disproportionate Impact of Food Allergies among Individuals of Different Ethnicities and Socioeconomic Backgrounds

A recent study published in the journal JAMA Network Open has shed light on the disproportionate effect of food allergies on people of color and those with lower incomes. The research, which examines food allergies across all age groups, highlights an often overlooked issue. Previous population-based studies on food allergies among people of color have been limited in number and mostly focused on children.

Food allergies occur when exposure to certain foods triggers an excessive immune response, leading to an attack on normally harmless proteins in the food. FARE, an advocacy organization for individuals with food allergies, reports that over 170 foods have been identified as potential triggers. Allergic reactions to food can range from mild symptoms such as an itchy mouth and hives to severe cases that cause breathing difficulties or even death. In the United States, approximately 200,000 people seek emergency medical care each year due to food allergies.

The study reveals that Asian, Black, and Hispanic individuals are more likely to report food allergies compared to White individuals. Specifically, the highest number of reported food allergies was observed among Hispanic (10.6%), Black (10.6%), and Asian (10.5%) populations. Asian and non-Hispanic White individuals experienced the lowest rates of severe food allergy reactions. In terms of socioeconomic factors, individuals from households earning over $150,000 per year had the fewest number of reported food allergies (8.3%).

The research also highlights notable differences in the types of food allergies experienced by different ethnic groups. Asian children exhibited the highest rates of tree nut allergies, while Asian adults had the highest rates of allergic reactions to shellfish and peanuts. For Black children, eggs and fin fish (such as tuna, halibut, and salmon) were the most common triggers. Among adults, Black individuals had the highest rates of allergic reactions to tree nuts. Hispanic adults reported higher rates of allergic reactions to hen's eggs and fin fish. Additionally, food allergy sufferers of any age who identified as Black were most likely to report issues with multiple foods (50.6%).

The nationally representative survey included 51,819 households and 78,851 individuals, conducted between October 2015 and September 2016. The study also examined the frequency of emergency room visits related to food allergies and the use of epinephrine, an injection used to treat breathing problems caused by allergic reactions. Epinephrine helps improve blood flow and relax muscles obstructing the airways, restoring normal breathing.

Earlier research has shown that approximately 11% of adults and 8% of children in the United States are affected by food allergies, equating to around 32 million Americans. Furthermore, the prevalence of food allergies appears to be increasing, as reported by the US Centers for Disease Control and Prevention. Among children alone, food allergies have seen a 50% increase between 1997 and 2011.

Although this study cannot definitively establish the reasons behind the higher prevalence of food allergies among people of color, it is unlikely to be solely attributed to genetics, according to Dr. Mahboobeh Mahdavinia, an associate professor of medicine at RUSH Medical College in Chicago. Environmental and socioeconomic factors are more likely to contribute to this disparity. The ongoing research suggests that exposure to certain environmental microbes may influence the gut microbiome, the collection of bacteria in the gastrointestinal tract, and increase susceptibility to food allergies. Pollution is also considered a potential factor, as people of color tend to reside in more polluted neighborhoods regardless of income. Living in poorly maintained apartment buildings with dusty or moldy hallways and uncleaned vents could have an impact.

Another contributing factor could be the "atopic march," a progression of allergic diseases that develop over a person's lifetime. For example, infants with eczema, an inflammatory skin condition, may have compromised skin barriers that allow increased allergen absorption from the environment, thereby increasing the risk of food allergies. The National Eczema Association reports that eczema is more prevalent among Black children (approximately 20%) compared to White (approximately 16%) or Hispanic children (approximately 8%).

Dr. Ruchi Gupta, a co-author of the study and director of the Center for Food Allergy and Asthma Research at Northwestern University Feinberg School of Medicine, emphasizes the importance of healthcare professionals being aware of the higher likelihood of food allergies among people of color and recommends screening for such allergies. Gupta believes that these disparities have been overlooked and underdiagnosed.

Education plays a significant role in the treatment of food allergies, according to Dr. Mahdavinia. Unfortunately, access to healthcare is closely linked to the outcomes for individuals with food allergies. Lack of access can result in poor outcomes. Currently, there is no specific treatment for food allergies, except for the use of an epinephrine auto-injector during severe reactions. However, several potential treatment options are in advanced stages of clinical trials.

Gupta emphasizes the importance of promptly diagnosing and planning for allergic reactions to food, as well as ensuring access to emerging treatments. She expresses concern about the growing disparities and urges efforts to prevent their further exacerbation.