Prevalence and Correlates of Food Allergy Among Medicaid-Enrolled United States Children

Bilaver, Lucy; Kanaley, Madeleine; Fierstein, Jamie; Gupta, Ruchi S.

doi:10.1016/j.acap.2020.03.005

Cited by 16 publications

(7 citation statements)

References 24 publications

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“…Food-induced anaphylaxis has been reported to occur more frequently in non-white children in both the United States [ 16 ] and the United Kingdom [ 17 ]. In contrast to the research by Gupta [ 11 , 12 ] and others [ 15 , 18 – 22 ], we did not observe an association of FA with Black race/ethnicity, potentially because of our small sample of this race/ethnicity (6.7%). Further, we observed that immigrants were less likely to report FA, whereas Gupta did not observe any association, potentially because her sample had a lower percentage of immigrants (8.4% versus 33.4% in ours) [ 11 ].…”

Section: Discussioncontrasting

confidence: 99%

“…An Australian study also reported a higher prevalence of nut allergy in children of mothers with higher education and socio-economic index [ 13 ]. Our finding that certain FA (i.e., peanut, fish, shellfish, and egg) occurred more frequently in those of Asian race/ethnicity has also been reported by Gupta [ 11 , 12 ] and others [ 14 , 15 ]. A small Canadian study involving 151 respondents reported a higher prevalence of shellfish allergy in Historically Underrepresented (i.e., Indigenous, Asian, Black, and East Indian) versus white participants [ 14 ].…”

Section: Discussionsupporting

confidence: 87%

“…A small Canadian study involving 151 respondents reported a higher prevalence of shellfish allergy in Historically Underrepresented (i.e., Indigenous, Asian, Black, and East Indian) versus white participants [ 14 ]. American studies have also reported a higher frequency of overall FA in Asian children [ 12 , 15 ] and adults [ 11 ] although they have not examined South and Southeast/East Asians separately as we did. Food-induced anaphylaxis has been reported to occur more frequently in non-white children in both the United States [ 16 ] and the United Kingdom [ 17 ].…”

Section: Discussionmentioning

confidence: 69%

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Demographic characteristics associated with food allergy in a Nationwide Canadian Study

Clarke

Elliott

Pierre

et al. 2021

Allergy Asthma Clin Immunol

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Introduction We conducted a nationwide Canadian telephone survey on food allergy prevalence between February 2016 and January 2017, targeting vulnerable populations (New, Indigenous, and lower-income Canadians). Objective To examine the independent effect of demographic characteristics on food allergy. Methods Canadian households with vulnerable populations were targeted using Canadian Census data and the household respondent reported whether each household member had a perceived (self-reported) or probable (self-report of a convincing history or physician diagnosis) food allergy. The association between perceived and probable food allergy and demographic characteristics was assessed through weighted multivariable random effects logistic regressions. Results Children, females, Canadian-born participants, adults with post-secondary education, and those residing in smaller households were more likely to report perceived or probable food allergy. Although immigrant parents self-reported less food allergy, Canadian-born children of Southeast/East Asian immigrant versus other immigrant or Canadian-born parents reported more food allergy. Conclusion We have demonstrated clear associations between demographic characteristics and food allergy, which may provide important clues to the environmental determinants of food allergy.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 69%

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Demographic characteristics associated with food allergy in a Nationwide Canadian Study

Clarke

Elliott

Pierre

et al. 2021

Allergy Asthma Clin Immunol

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“…The prevalence of FA was reported in reference to the national poverty level at the time of analysis: less than 100% of the poverty level, between 100% and 200%, and above 200%, which differ from the 5 categories used for the analyses of our study. In addition, only 0.6% of children enrolled in Medicaid had an FA diagnosis compared with the general population of children with a confirmed, physician-diagnosed FA prevalence rate of 5% . However, children and adults enrolled in Medicaid may not be able to obtain an accurate physician diagnosis of FA because there is less access to specialist care.…”

Section: Discussionmentioning

confidence: 99%

Racial, Ethnic, and Socioeconomic Differences in Food Allergies in the US

et al. 2023

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ImportanceFood allergies affect approximately 8% of children and 11% of adults in the US. Racial differences in food allergy outcomes have previously been explored among Black and White children, but little is known about the distribution of food allergies across other racial, ethnic, and socioeconomic subpopulations.ObjectiveTo estimate the national distribution of food allergies across racial, ethnic, and socioeconomic groups in the US.Design, Setting, and ParticipantsIn this cross-sectional survey study, conducted from October 9, 2015, to September 18, 2016, a population-based survey was administered online and via telephone. A US nationally representative sample was surveyed. Participants were recruited using both probability- and nonprobability-based survey panels. Statistical analysis was performed from September 1, 2022, through April 10, 2023.ExposuresDemographic and food allergy–related participant characteristics.Main Outcomes and MeasuresStringent symptom criteria were developed to distinguish respondents with a “convincing” food allergy from those with similar symptom presentations (ie, food intolerance or oral allergy syndrome), with or without physician diagnosis. The prevalence of food allergies and their clinical outcomes, such as emergency department visits, epinephrine autoinjector use, and severe reactions, were measured across race (Asian, Black, White, and &gt;1 race or other race), ethnicity (Hispanic and non-Hispanic), and household income. Complex survey-weighted proportions were used to estimate prevalence rates.ResultsThe survey was administered to 51 819 households comprising 78 851 individuals (40 443 adults and parents of 38 408 children; 51.1% women [95% CI, 50.5%-51.6%]; mean [SD] age of adults, 46.8 [24.0] years; mean [SD] age of children, 8.7 [5.2] years): 3.7% Asian individuals, 12.0% Black individuals, 17.4% Hispanic individuals, 62.2% White individuals, and 4.7% individuals of more than 1 race or other race. Non-Hispanic White individuals across all ages had the lowest rate of self-reported or parent-reported food allergies (9.5% [95% CI, 9.2%-9.9%]) compared with Asian (10.5% [95% CI, 9.1%-12.0%]), Hispanic (10.6% [95% CI, 9.7%-11.5%]), and non-Hispanic Black (10.6% [95% CI, 9.8%-11.5%]) individuals. The prevalence of common food allergens varied by race and ethnicity. Non-Hispanic Black individuals were most likely to report allergies to multiple foods (50.6% [95% CI, 46.1%-55.1%]). Asian and non-Hispanic White individuals had the lowest rates of severe food allergy reactions (Asian individuals, 46.9% [95% CI, 39.8%-54.1%] and non-Hispanic White individuals, 47.8% [95% CI, 45.9%-49.7%]) compared with individuals of other races and ethnicities. The prevalence of self-reported or parent-reported food allergies was lowest within households earning more than $150 000 per year (8.3% [95% CI, 7.4%-9.2%]).Conclusions and RelevanceThis survey study of a US nationally representative sample suggests that the prevalence of food allergies was highest among Asian, Hispanic, and non-Hispanic Black individuals compared with non-Hispanic White individuals in the US. Further assessment of socioeconomic factors and corresponding environmental exposures may better explain the causes of food allergy and inform targeted management and interventions to reduce the burden of food allergies and disparities in outcomes.

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“…Food allergy (FA) or food allergies are pathologies triggered by exposure to food allergens [ 1 ]. The prevalence of immunoglobulin (Ig) E-mediated FA in children has increased in recent years, with figures ranging from 1 to 2.53% in the USA [ 2 ] and Canada [ 3 ] to 5.5% in Chile [ 4 ]. Higher proportions are observed in self-report studies, reaching up to 25% in some regions [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Contribution of Gut Microbiota to Immune Tolerance in Infants

Méndez

Bueno

Kalergis

2021

Journal of Immunology Research

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The prevalence of food allergy has increased in recent years, especially among the pediatric population. Differences in the gut microbiota composition between children with FA and healthy children have brought this topic into the spotlight as a possible explanation for the increase in FA. The gut microbiota characteristics are acquired through environmental interactions starting early in life, such as type of delivery during birth and breastfeeding. The microbiota features may be shaped by a plethora of immunomodulatory mechanisms, including a predominant role of Tregs and the transcription factor FOXP3. Additionally, a pivotal role has been given to vitamin A and butyrate, the main anti-inflammatory metabolite. These observations have led to the study and development of therapies oriented to modifying the microbiota and metabolite profiles, such as the use of pre- and probiotics and the determination of their capacity to induce tolerance to allergens that are relevant to FA. To date, evidence supporting these approaches in humans is scarce and inconclusive. Larger cohorts and dose-titration studies are mandatory to evaluate whether the observed changes in gut microbiota composition reflect medical recovery and increased tolerance in pediatric patients with FA. In this article, we discuss the establishment of the microbiota, the immunological mechanisms that regulate the microbiota of children with food allergies, and the evidence in research focused on its regulation as a means to achieve tolerance to food allergens.

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Prevalence and Correlates of Food Allergy Among Medicaid-Enrolled United States Children

Cited by 16 publications

References 24 publications

Demographic characteristics associated with food allergy in a Nationwide Canadian Study

Demographic characteristics associated with food allergy in a Nationwide Canadian Study

Racial, Ethnic, and Socioeconomic Differences in Food Allergies in the US

Contribution of Gut Microbiota to Immune Tolerance in Infants

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