Food allergy phenotypes and healthcare use appear to vary among children of different racial and ethnic backgrounds. Recognizing these differences can help clinicians improve how they manage specific patient groups that may be at higher risks of certain allergies.
Data indicate that the prevalence of food allergy (FA) has been increasing among children of all races/ethnicities in the United States, with some studies showing that African-American children are at increased risk for FA and its associated morbidities. However, data are lacking on the severity and outcomes of FA in minority children, according to Mahboobeh Mahdavinia, MD, PhD. “Nearly all available information is focused on Caucasian children because food allergies are thought to be an issue of affluent societies and higher-income families, which is fed by the hygiene hypothesis,” she says. “There has been little focus to determine if minority children are different in that concept.”
Characterizing Differences
For a study published in The Journal of Allergy and Clinical Immunology: In Practice, Dr. Mahdavinia and colleagues sought to characterize racial/ethnic differences in FA phenotype and healthcare utilization among food-allergic children. “We compared the outcome of FA with a focus on severe reactions to food and anaphylaxis among 817 African-American (about 50%), Hispanic (about 30%) or Caucasian children with a FA diagnosis,” explains Dr. Mahdavinia.
When compared with Caucasian children, African-American (odds ratio [OR], 2.34) and Hispanic (OR, 2.88) children had significantly higher rates of food-induced anaphylaxis. Both groups of minority children also had higher odds of emergency department visits for FA-related reactions. “These findings call for special attention in these groups of children,” Dr. Mahdavinia adds.
In assessing comorbid allergic conditions, the study team found that African-American children had significantly higher odds of comorbid asthma than Caucasian children and that both African-American and Hispanic children had significantly higher odds of eczema. However, rates of allergic rhinitis were similar across the three groups among those who were evaluated via skin prick testing.
Specific Foods
The researchers also found peanuts to be the most common food allergen across all three groups, and that rates of allergy to peanut, egg, and milk were similar among all children in the study (Table). However, rates of allergy to corn, shellfish, and fish were significantly higher in Hispanic and African-American children, and rates of allergy to wheat and soy were significantly higher in African-American children, when compared with Caucasian children. “The only type of food that Caucasians were more commonly allergic to were tree nuts,” says Dr. Mahdavinia.
The researchers believe high rates of specific FA result from the types of food children are exposed to, and when, during early childhood. “This is an important consideration, because foods like corn, wheat, and milk are difficult to remove from one’s diet or household, which sets children with FA up for increased risk of accidental exposure,” explains Dr. Mahdavinia. “It’s difficult to have, for example, a wheat-free home, but it’s much easier to have an almond-free home. When these children are exposed to bread, there are greater chances for them to accidentally ingest the food they’re allergic to, which may explain some of the increased ER visit or anaphylaxis rates seen among minority children.”
Dr. Mahdavinia suggests that the higher rates of FA-related anaphylaxis and ED visits among African-American and Hispanic children, when compared with Caucasian children, may result in part from the higher rates of asthma, and more severe asthma, among African Americans and Hispanics. “When a child with FA and asthma ingests a food they’re allergic to, they usually experience a severe asthma exacerbation,” she adds. “In children with asthma, they experience breathing difficulties that can become a life-threatening issue requiring emergency care.”
Changing Minds
The belief that FA is a problem mainly of Caucasian children is something clinicians need to reevaluate, according to Dr. Mahdavinia. “When clinicians care for African-American children, they should obtain a detailed history that includes FA-related information,” she says. “Some parents won’t provide that information without being asked . Information in patient-directed reading material also needs to be changed, as most are not racially sensitive. These changes will hopefully help improve FA-related outcomes for all children.”
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