Racial and ethnic disparity in food allergy in the United States: a systematic review

Abstract

Background: The prevalence of food allergy is rising among US children. Little is known about racial/ethnic disparities in food allergy.

Objective: We performed a systematic literature review to understand racial/ethnic disparities in food allergy in the United States.

Methods: We searched PubMed/MEDLINE, Embase, and Scopus for original data about racial/ethnic disparities in the diagnosis, prevalence, treatment, or clinical course of food allergy or sensitization, with a particular focus on black (African American) race. Articles were analyzed by study methodology, racial/ethnic composition, food allergy definition, outcomes, summary statistic used, and covariate adjustment.

Results: Twenty of 645 identified articles met inclusion criteria. The studies used multiple differing criteria to define food allergy, including self-report, sensitization assessed by serum food-specific IgE to selected foods without corroborating history, discharge codes, clinic chart review, and event-reporting databases. None used oral food challenge. In 12 studies, black persons (primarily children) had significantly increased adjusted odds of food sensitization or significantly higher proportion or odds of food allergy by self-report, discharge codes, or clinic-based chart review than white children. Major differences in study methodology and reporting precluded calculation of a pooled estimate of effect.

Conclusion: Sparse and methodologically limited data exist about racial/ethnic disparity in food allergy in the United States. Available data lack a common definition for food allergy and use indirect measures of allergy, not food challenge. Although data suggest an increased risk of food sensitization, self-reported allergy, or clinic-based diagnosis of food allergy among black children, no definitive racial/ethnic disparity could be found among currently available studies.

Keywords: 95% Predictive Decision Points; African American; Anaphylaxis; Black; Children; Disparity; Epinephrine; Ethnicity; Food allergy; Food sensitization; Prevalence; Race; Serum IgE.