Allergy & Immunology

Food Allergies


Racial, Ethnic, and Socioeconomic Considerations in the Management of Food Allergies

patient care perspectives by Ruchi Gupta, MD, MPH

Although food allergies impact all of society, their burden can differ based on a patient’s race, ethnicity, or socioeconomic status (SES). Information on the racial, ethnic, and socioeconomic factors that health care providers should consider when treating patients with food allergies is provided.

Expert Commentary
“About 20 years ago, I think that disparities were less evident, even though food allergies impact all racial and ethnic groups. Certain groups are impacted differently.”
— Ruchi Gupta, MD, MPH

Broadly speaking, we know that disparities in food allergies exist by race, ethnicity, and SES. About 20 years ago, I think that disparities were less evident, even though food allergies impact all racial and ethnic groups. Certain groups are impacted differently. For example, it is well known that shellfish and fish allergies are more common among black children and that some tree nut allergies are more common among Asian children.


Although approximately 8% of all children in the United States have a food allergy, a study published several years ago showed that only 0.6% of children in the Medicaid database were diagnosed. Why is that? I think that the main reason is because patients do not have equal access to allergists to get diagnosed. In my practice, I have seen that a lot of children with a low SES have multiple medical issues, including asthma. They avoid the food, so it is not a priority. Instead, the priority is getting their asthma or other medical issue(s) under control.


Often, families do not even bring up food allergies. In their minds, food allergies are not like asthma, which has specific treatments. However, because we now have treatments and can do more than just tell them to avoid the food and take epinephrine, it is even more important that we identify and diagnose food allergies so that we can get people the treatments that they need. Many children with a low SES do not have epinephrine autoinjectors. And if they do have them, they can often only get generic ones, which I think are a little harder to use. Studies show that children with a low SES use epinephrine less frequently overall and are less likely to use it prior to going to the Emergency Department.


To address some of these disparities, I think that we need to go into the community and really support people’s understanding of food allergies and how to manage them. Schools are another place where we can have a significant impact. A lot of food allergies are discovered for the first time in child care centers and schools. So, it is very important that all child care centers, schools, and universities have clear training and policies on food allergies and that they stock epinephrine. These are places where we can get education, training, and awareness on food allergies to teachers and children in the community.


Bilaver LA, Kanaley MK, Fierstein JL, Gupta RS. Prevalence and correlates of food allergy among Medicaid-enrolled United States children. Acad Pediatr. 2021;21(1):84-92. doi:10.1016/j.acap.2020.03.005


Gupta RS, Warren CM, Smith BM, et al. The public health impact of parent-reported childhood food allergies in the United States. Pediatrics. 2018;142(6):e20181235. Published correction appears in Pediatrics. 2019;143(3):e20183835.


Huang F, Chawla K, Järvinen KM, Nowak-Węgrzyn A. Anaphylaxis in a New York City pediatric emergency department: triggers, treatments, and outcomes. J Allergy Clin Immunol. 2012;129(1):162-8.e1-3. doi:10.1016/j.jaci.2011.09.018


Jiang J, Warren CM, Brewer A, Soffer G, Gupta RS. Racial, ethnic, and socioeconomic differences in food allergies in the US. JAMA Netw Open. 2023;6(6):e2318162. doi:10.1001/jamanetworkopen.2023.18162


Kanaley MK, Dyer AA, Negris OR, et al. Guideline-informed care among Medicaid-enrolled children with food allergy. Am J Manag Care. 2020;26(12):505-512. doi:10.37765/ajmc.2020.88538

Ruchi Gupta, MD, MPH

    Professor of Pediatrics and Medicine
    Director, Center for Food Allergy & Asthma Research
    Northwestern University Feinberg School of Medicine
    Clinical Attending, Ann & Robert H. Lurie Children’s Hospital of Chicago
    Chicago, IL