Socioeconomic disparities hinder children’s recovery from food allergies, study finds

Research reveals that children from lower-income families and minority backgrounds have significantly reduced chances of outgrowing food allergies, highlighting the impact of social determinants on health outcomes.

A study published in Annals of Allergy, Asthma & Immunology suggests that children from lower socioeconomic backgrounds are less likely to outgrow food allergies, with sharp disparities seen across race, income and parental health literacy. Researchers found that Black and Hispanic children had significantly lower odds of food allergy resolution than white children, while lower household income and lower parental health literacy were also linked with a reduced chance of tolerance developing over time.

The multicentre FORWARD study followed 1,359 children with at least one IgE-mediated food allergy, a type of allergy driven by the immune system’s production of allergen-specific antibodies. Of the children studied, 337 had already outgrown at least one allergy at enrolment. Those children were more likely to be white, to live in higher-income households and to have parents with stronger health literacy, according to the findings reported by Healio and summarised in the journal abstract.

Mahboobeh Mahdavinia, an allergist and immunologist at UTHealth Houston, said the pattern points to more than biology. Speaking to Healio, she said that access to care may help determine whether a child’s improvement is recognised and documented, noting that families who attend specialist appointments more regularly are more likely to have allergy outgrowth identified. Her team’s analysis also found that a higher number of allergy-related clinic visits was associated with lower odds of documented resolution, which the researchers said may reflect more severe or persistent disease, as well as differences in follow-up.

The study also showed that resolution varied by allergen. Milk, especially baked milk, resolved most often, followed by soy, wheat and egg, while peanut, sesame, tree nut, finned fish and shellfish allergies were much less likely to disappear. The youngest average age of resolution was for milk allergy, at about 41 months, while shellfish tended to resolve latest. In the subgroup of children with a history of reaction, Black children had roughly one-quarter the odds of resolution seen in white children, and Hispanic children had similarly reduced odds. Comparable gaps appeared in allergen-specific analyses for egg, milk, peanut, finned fish and shellfish.

Earlier reporting by HCPLive and the journal abstract also highlighted that annual household income of at least $100,000 and higher parental health literacy were associated with better odds of resolution, while a lower area deprivation index, a measure of neighbourhood advantage, tracked with improved outcomes. Together, the findings add to a wider body of research showing that food allergy burden and outcomes are shaped by social conditions as well as clinical factors. Mahdavinia said her group is now studying how individual allergens evolve in early childhood and whether microbiome markers could help predict which children are most likely to outgrow their allergies.