Racial gaps persist in food allergy
Although there have been improvements over the years, racial, socioeconomic and ethnic disparities in food allergy are still prevalent in the United States, according to a presentation at the American College of Asthma, Allergy & Immunology Scientific Meeting.
Ruchi S. Gupta, MD, MPH, a professor of pediatrics and medicine at Northwestern University Feinberg School of Medicine, explained that although previous work examined racial differences in asthma and rhinitis presentations, “in food allergy, it’s not an area that we’ve had a ton of research in.”
Gupta and Rachel Peters, PhD, a research fellow at the Center for Food & Allergy research at Murdoch Children’s Research Institute in Victoria, Australia, discussed recent findings in food allergy that physicians should be aware of.
Food allergy prevalence by race
Gupta explained that studies of the prevalence of food allergy by race have had varying results. For instance, one study using retrospective data found that hospitalizations and ED visits for food-induced anaphylaxis increased more in African American children than white children between 2008 and 2012.
However, the National Health Interview Survey found that from 2001 to 2013, white children had the highest prevalence of food allergy based on responses to the question, “during the past 12 months, did your child have any kind of food allergy?”
To provide more recent data, Gupta and colleagues conducted a survey of U.S. households from 2015 to 2016 and analyzed the responses of 38,408 children and 40,442 adults. They found that when broken down by race, the prevalence of patient-reported, convincing, and physician-diagnosed food allergy were higher in African American and Hispanic children compared with white children. They found a significantly higher number of Asian and Hispanic adults reported food allergy compared with white adults.
In another study assessing trends in physician diagnosis of food allergy by race and household income, researchers found that in 2011, the prevalence of physician-diagnosed food allergy among patients reporting convincing symptoms of food allergy was significantly higher in white children compared with Asian, Hispanic, and African American children. By 2018, the prevalence of food allergy diagnosis increased to similar rates as white children for most minority groups, but Asian children and those with a household income below $50,000 per year remained low.
The same study found that food allergy-related ED visits in the last 12 months and over the patients’ lifetimes were higher among African American and Hispanic children and adults compared with white children and adults.
Socioeconomic burden of food allergy
According to Peters, one study found that the financial burden of food allergy in the United States totaled nearly $24.8 billion a year, or more than $4,000 per child. The total costs to families was $20.1 billion each year.
High out-of-pocket costs and direct medical costs can make it difficult to afford care, she explained.
“Determining racial and socioeconomic barriers to the appropriate management of food allergy is really important for physicians and policymakers to understand,” Peters said.
Another study, which evaluated the economic effects of childhood food allergy, found significantly different health care costs when stratified by race. For instance, they found that African American families incurred lower ED and hospital costs and spent significantly less on out-of-pocket costs.
These differences could not be explained by household income, Peters said. The study found that children in the lowest income bracket incurred expenses for ED visits and hospitalizations 2.5 times greater than children from higher-income families. However, children from low-income families had significantly lower costs for specialist visits and out-of-pocket medical costs compared with children from higher-income families.
“This suggests that children from lower-income families may be at higher risk for accidental ingestion or anaphylaxis because they may have less access to specialist care, allergen-free foods or emergency medications,” Peters said during the presentation.
She noted that “clinicians need to be aware of these children and work with low-income and minority families to ensure that they can access specialty care and needed medications, such as epinephrine.” – by Erin Michael
Zachary CY, et al. Racial, ethnic and socioeconomic disparities in food allergy. Presented at: American College of Asthma, Allergy & Immunology Scientific Meeting; Nov. 7-11, 2019; Houston.
Disclosures: Gupta reports relationships with Aimmune, BEFORE Brands, DBV and Kaleo. Peters reports no relevant financial disclosures.