People of color have more food allergies than White people, study finds

By Jen Christensen, CNN

(CNN) — People of color and those in lower income brackets seem to be disproportionately affected by food allergies, compared with people who are White and at higher incomes, a new study finds.

It’s an issue that often flies under the radar, according to the authors of the study, which was published Wednesday in the journal JAMA Network Open. There have been only a handful of previous population-based studies on food allergies among people of color, and most of those focus on children. The new research looks at food allergies among people of all ages.

An allergic reaction to food happens when exposure triggers the immune system to go into overdrive and attack the proteins in the food that are normally harmless. More than 170 foods have been reported to cause allergic reactions, according to FARE, an advocacy organization for people with food allergies.

An allergic reaction to food can be as mild as an itchy mouth and a case of hives or so severe that it can cause trouble breathing or even death. In the US, food allergies send about 200,000 people to emergency medical care every year, according to FARE.

The new study found that Asian, Black and Hispanic people were much more likely to report having food allergies than White people. Specifically, people with the highest number of food allergies identified as Hispanic (10.6%), Black (10.6%) and Asian (10.5%).

Asian and non-Hispanic White people had the lowest rates of severe food allergy reactions. In terms of economics, those who had the lowest number of food allergies lived in households that earned more than $150,000 per year (8.3%).

The study found some notable differences in the kind of foods people are allergic to. Among children, Asian children seemed to have the highest rates of tree nut allergy. Asian adults had the highest rates of allergic reactions to shellfish and peanuts. Eggs and fin fish, like tuna, halibut and salmon, were the biggest trigger for Black children. Among adults, Black adults had the highest rates of allergic reactions to tree nuts. For Hispanic adults, it was hen’s eggs and fin fish. Black people of any age with food allergy were most likely to report problems with multiple foods (50.6%).

This nationally representative survey included 51,819 households with a total of 78,851 people, surveyed between October 2015 and September 2016. The study also looked at the number of trips people have taken to the ER because of their food allergies and the number who have had to use epinephrine, an injection that treats breathing problems caused by allergic reactions. Epinephrine helps increase blood flow through the veins and relax muscles blocking the airways, allowing breathing to return to normal.

In general, food allergies affect 11% of adults and 8% of children in the US, earlier research has shown – about 32 million Americans. And the number seems to be rising, according to the US Centers for Disease Control and Prevention. Among children alone, food allergies increased 50% between 1997 and 2011, the CDC says.

This new study cannot determine why more people of color have food allergies, but it’s probably not an issue of genetics, said Dr. Mahboobeh Mahdavinia, an associate professor of medicine in the Department of Internal Medicine in the Division of Allergy & Immunology at RUSH Medical College in Chicago.

“The majority of this is likely driven by the environment and the social economy factors that impact environments that people are born into and live in as adults,” said Mahdavinia, who was not involved in the study.

Research that is now underway seems to suggest that exposure to certain microbes in the environment may affect the gut microbiome, the collection of bacteria that live in a person’s gastrointestinal tract, and that could leave someone susceptible to developing food allergies, Mahdavinia said.

Pollution could also be a problem, and research shows that people of color tend to live in more polluted neighborhoods, regardless of income. Living in apartment buildings where the vents aren’t cleaned as well, for example, or the hallways are dusty or moldy could have an impact.

It could also be related to “atopic march,” a progression of allergic diseases that develop over the course of someone’s life. The skin of babies who have eczema, an inflammatory skin condition, for instance, may not properly protect the body from absorbing more allergens from the environment, creating a higher risk of food allergy, Mahdavinia said. Eczema affects more Black children (about 20%) than White (about 16%) or Hispanic children (about 8%) in the US, according to the National Eczema Association.

“Is it microbiome or disparities that we see causing other conditions that are related to food allergy, or is there something in the environment that’s triggering more food allergies? We don’t completely know,” said Dr. Ruchi Gupta, a co-author of the new study and the director of the Center for Food Allergy and Asthma Research and a professor of pediatrics at Northwestern University Feinberg School of Medicine.

Regardless of the reason, Gupta thinks it is important for doctors to be aware that people of color are more likely to have food allergies and says they should screen for them. “I think these disparities have been a little bit hidden and are not getting diagnosed,” she said.

A big part of treatment for these allergies involves education, Mahdavinia said.

“Unfortunately, it is completely linked to access to health care, and if that is lacking, then we have to deal with the consequences, which is poor outcomes,” she said.

There is no specific treatment for food allergies other than an epinephrine auto-injector for a severe reaction, but some possible options are far along in clinical trials, Gupta said.

“If an allergic reaction to food occurs, it’s really, really important to get that diagnosis and plan and then have access to these new treatments when they come out,” she said. “I don’t want to see these disparities grow.”

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