Pediatric food allergy prevalence and trends by race and ethnicity

In the United States, food allergies (FAs) disproportionately affect children based on their racial or ethnic heritage, though there are some gaps and discrepancies in the literature about the prevalence of FAs among different groups.

The objective was to analyze clinical data to determine how FA prevalence varies based on race and ethnicity and to track FA diagnosis rates over time.

Patient FA diagnoses, birth years, and self-reported races or ethnicities were analyzed for 298,476 pediatric patients in the Children's Hospital of Philadelphia network. Odds ratios (OR) for FA were calculated for each race or ethnicity, controlling for sex, insurance type, and birth year. The percentages having each of the top 9 FAs and ORs for being allergic to a particular allergen and multiple allergens were calculated for each race or ethnicity using a subset of data for 20,582 food-allergic children. The percentages of each birth cohort diagnosed with FA were plotted.

Asian/Pacific Islander (A/PI) children had the highest odds of FA (OR, 1.92; CI, 1.80-2.05) and multiple FAs (OR, 1.55; CI, 1.37-1.76). The most common allergens varied between groups. All groups had higher odds than White children of allergies to fish and shellfish, but only A/PI children also had higher odds of peanut, egg, wheat, and sesame allergies. FA diagnoses appeared to increase until the 2004 birth cohort and remain steady through the 2008 birth cohort.

Clinicians, researchers, and outreach coordinators should be aware of the potential for a significantly greater risk of FA for children of A/PI heritage in the United States. Additional studies that intentionally include patients from these demographics and monitor FA trends over time are warranted.