STUDY: Research Reveals Black and Inner-City Children Are at Greater Risk for Food Allergies

Black children are at greater risk for food allergies, with a higher frequency of emergency room visits. But, they are less likely to be diagnosed with food allergies, to receive the allergist care they need, and to have a current epinephrine prescription. Learn more about food allergy inequities affecting the Black community.

Like many other health issues, food allergies disproportionately impact the Black community. This is likely due to several factors, including structural racism and access inequities.

Black children tend to be the racial group most impacted by food allergies in the United States, with the most difficulty accessing food allergy care. This is especially significant since food allergies can be life-threatening.

While other nonwhite racial groups--- Native Americans, Asian-Americans and Hispanic Americans--- also seem to be more significantly impacted by food allergies than their white peers, the Black community is burdened most.

Black children also tend to be underrepresented in food allergy studies around the world. But recent research from the past decade shines a light on just how significantly food allergies impact Black Americans, especially children.

Findings from recent research include:

  • Black children are at higher risk of developing food allergies.
  • But, they are less likely to be diagnosed with a food allergy, and less likely to receive comprehensive allergist care.
  • Black children are also less likely to have an epinephrine prescription for their food allergy.

Now, let's examine the recent studies in more detail.

2010: Black Children, Especially Boys, More Likely To Suffer From Food Allergies

The first U.S. study that examined food allergies in all age groups from age 1 to over age 60, and that also examined racial differences in food allergy prevalence, took place in 2010.

In that study, Dr. Andrew Liu (University of Colorado) and his peers used blood tests to check for specific IgE antibodies. (These antibodies cause the body to develop an allergic reaction when the immune system detects proteins from a certain food.)

The study showed that Black Americans of all ages were more likely to have food allergies than their peers of other races. Black children, and especially younger Black boys, were most likely to have a food allergy than their peers. As a press release that shared the study's findings reported, "The odds of male black children having food allergies were 4.4 times higher than others in the general population."

2011: Black Children Are At Higher Risk For A Food Allergy, But Less Likely To Be Diagnosed

Dr. Ruchi Gupta's well-known 2011 study on the prevalence of food allergies found that Black children were more likely to suffer from a food allergy than their peers, and more likely to experience an allergic reaction. Unfortunately, the study also showed that Black children were less likely to be diagnosed with a food allergy, meaning they were also less likely to receive the care and guidance they needed from an allergist.

2014: The Rate Of Food Allergies Nearly Doubled In Black Children Over 23 Years

In a 2014 study, Dr. Corinne Keet and others found that, between 1988 and 2011, self-reported food allergies increased much more sharply in Black (non-Hispanic) children compared to their white and Hispanic peers.

During that 23-year span, food allergies in Black children increased by 2.1 percent. Meanwhile, food allergies only increased by 1.2 percent among Hispanic children, and by 1 percent among white children. So, Black children were again shown to be disproportionately impacted by food allergies.

This finding is based on data from the parents of over 450,000 American children.

It's important to note that this study looked at self-reported food allergies, not diagnosed food allergies. Many of the children, of all races, didn't see an allergist who could properly confirm that they had a food allergy. And, as other studies have covered, even though Black children are more likely to have a food allergy, they're also less likely to see an allergist.

2014: Inner-City Children Have Higher Food Allergy Risk

According to another 2014 study by Dr. Emily McGowan and others, inner-city children are at greater risk for food allergies compared to the general population. And in the inner-city population that was examined in this study, 71% of the 516 children were Black.

9.9% of the inner-city children developed a food allergy by the age of 5, while 6.5% of the children in the general population developed a food allergy by the age of 5. And these percentages were based on confirmed, diagnosed food allergies, not self-reports.

Previously, the estimates of food allergies among inner-city kids were much lower. According to the 2014 study, those previous lower numbers are a sign that inner-city children are less likely to have their food allergy diagnosed, and less likely to receive specialized treatments for their food allergy, even though food allergy rates are higher in this population.

2016: Black Children Have High Rates Of Specific Allergies

A 2016 Journal of Allergy and Clinical Immunology (JACI) study led by Dr. Mahboobeh Mahdavinia went into detail on rates of specific food allergies in children of different races. The study involved 817 Black, Hispanic and white children who had at least one food allergy, ranging in age from 0-17.

Compared to white children, the study found that Black children "had significantly higher rates of allergy to wheat, soy, corn, fish and shellfish."

The Black children were also more likely to have asthma or eczema, two conditions closely related to food allergies.

Meanwhile, Hispanic children also had significantly higher rates of corn, fish, and shellfish allergies than their white peers, but didn't have higher rates of soy or wheat allergies.

Black and Hispanic children were also more likely to have an anaphylactic reaction due to their food allergy, and more likely to receive allergy-related emergency care.

But compared to white children, Black and Hispanic children spent less time at follow-up appointments with an allergist, possibly indicating that more families in these populations struggle to access and afford allergist care.

Dr. Mahdavinia was especially concerned about the rate of wheat allergies in Black children, since wheat is so common. He believes that this may be part of the reason why Black children develop anaphylaxis more often, and require emergency care more often. Says Dr. Mahdavinia, "The higher rate of wheat allergy among African American children could potentially explain the higher rates of anaphylaxis … and the emergency room visits observed in this population.”

2018: Black Children Have Higher Food Allergy Rates, But Are Less Likely To Have An Epinephrine Prescription

Building on her previous research in 2011, a study that Dr. Ruchi Gupta conducted in 2018 showed several food allergy-related burdens that the Black community faces.

The 2018 study again showed that Black (non-Hispanic) children were at "significantly elevated risk" for a food allergy compared to their white (non-Hispanic) peers.

While Hispanic children were also more likely to have a food allergy than their white peers, rates of food allergy in Hispanic children were lower than rates of food allergy in Black children.

Black and Hispanic children were also less likely to have a current epinephrine prescription, but more likely to have visited the emergency department for food allergy care. Epinephrine is the only medicine that can stop a severe, life-threatening allergic reaction. Not having epinephrine can lead to serious consequences --- and could even be deadly.

But the 2018 study's findings show that it may be more difficult for Black families to access epinephrine --- especially since they're already less likely to be diagnosed with a food allergy in the first place, and less likely to receive allergist care.

Where Do We Go From Here? Taking Action

Based on the findings from several studies over the past decade, several actions are needed to create more equitable care for Black children with food allergies --- and to address what factors may lead to higher food allergy rates among Black children in the first place.

  • Barriers that keep Black children from accessing allergist care, including economic ones, need to be removed.
    • Increased allergist care will significantly improve the quality of life for Black children with food allergies.
    • Allergist guidance may also help cut down the higher rates of allergy-related emergency visits among Black American children.
  • Epinephrine must be made available more widely, at a lower cost, so Black families (and all families) can access it more easily.
  • Access to allergen-free food options is needed to cut down allergy-related emergency room visits.
    • Wheat-free and soy-free options are especially important.
    • Black children tend to have higher rates of these allergies, but wheat and soy are common in many foods and are hard to avoid.
  • More studies are needed to find out why food allergy rates are so much higher in Black children than their peers.
  • Previous landmark studies and recent clinical guidelines recommend to introduce potential allergy-causing foods early in life
    • For example, new USDA 2020 Dietary Guidelines (DGA) recently released by the U.S. Department of Agriculture (USDA) states to, "Introduce infants to potentially allergenic foods along with other complementary foods”
    • So, more education on early allergen introduction would be especially beneficial for Black communities, where food allergy rates are higher.

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