Pediatric IgE mediated food allergies and ethnic group inequalities: A scoping review

The prevalence of pediatric food allergy ranges between 8% and 10% depending on age, geographic location, and the diagnostic criteria. There is considerable variation in clinical manifestation, with disparities in symptoms and phenotypes related to race, ethnic group, and coexisting allergic disease(s). The current evidence on ethnic group and racial differences remains limited and inconsistent. This scoping review aimed to explore the existing evidence on ethnic group and race health inequalities in pediatric IgE mediated food allergies in high-income countries.

We conducted a systematic search using MEDLINE, Embase, and CINAHL, inclusive of grey literature from database inception to November 2024. Observational and qualitative studies reporting data for children aged 0-19 years with professional diagnosis of IgE-mediated food allergy, and ethnic group or race in high-income countries, without language restrictions, were included. Screening and data extraction were performed independently in duplicate. Results were mapped thematically and reported descriptively. The review was conducted using Joanna Briggs Institute (JBI) methodology for scoping reviews and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines.

Searches identified 4373 results, and 37 studies were included reporting pediatric IgE mediated food allergy and ethnic group data. Only 17 studies explicitly reported ethnic group differences, with most studies focused on prevalence. Nine studies examined prevalence differences, generally showing higher rates of food allergy among Black and Asian children compared with White children. Three studies examined differences in access to care and management between Black and Hispanic/Latino children and White children. Patterns showed White children had greater access to allergen-free foods and were over-represented in oral immunotherapy and more likely to receive epinephrine. Five studies examined health outcome severity, with some evidence suggesting Black children had the highest rates of food-induced anaphylaxis, and greater odds of asthma and allergic rhinitis compared with White children.

Evidence to-date suggests there are ethnic group and racial differences among children with IgE-mediated food allergy related to prevalence, access to care and management, and health outcomes. However, there is incomplete and inconsistent reporting of ethnicity. Only 17 of the 37 included studies that included ethnic group and race data analyzed and reported ethnic group differences. This limits the field's capacity to understand inequalities and additional care requirements for minoritized and racialized ethnic groups. Further research is vital to inform the development of allergy services for children to ensure they have equitable access to care and treatment, as well as optimal health outcomes, regardless of ethnic group and race.