Let's Talk About Racial Disparities & Food Allergies

I have been reflecting a lot in light of the recent murders of Ahmaud Arbery, Breonna Taylor, and George Floyd. I’ve been asking myself, “What are some of the things I have taken for granted in my life? How has my experience been seen as the default? How has my white privilege benefited me in ways I’ve never been aware of? How would my life experiences be different if I was not a white/white-passing multiracial person?”


The answers to these questions are never-ending. I have and continue to benefit from my whiteness every day in countless ways because of the system of oppression, colonialism, and white supremacy that we live in. As I started to think about my experiences with my severe food allergies, I began to notice all the ways my privilege has helped me survive my most life-threatening reactions. For as long as I can remember, I have had access to epinephrine auto-injectors, which are notoriously expensive. I’ve never had to worry about whether a hospital would treat me differently because of my race. I have always had health insurance, attended countless allergist appointments, and been able to have allergy testing done without a problem. I have always been able to receive albuterol inhaler prescriptions for my asthma and topical creams for eczema I had as a child, both of which are issues that are commonly linked with food allergies.


I decided to educate myself on the racial inequalities in food allergies, food allergy treatment, and healthcare as a whole. In my research, the findings that I came across were disheartening, infuriating, but not surprising given the ongoing history of institutional violence and racism this country has. I want to share some of the things I’ve learned to bring awareness to this topic that is not frequently addressed within the food allergy community, to shed light on the importance of non-Black people educating ourselves and understanding our privileges, and to emphasize that BLACK LIVES MATTER. Racism exists in every aspect of our society--food allergy treatment and healthcare are no exceptions.


Although the rate of food allergies has been increasing across all races and ethnicities in recent years, there are racial differences in the prevalence of food allergies and their treatment. In one survey of almost 40,000 children, researchers found that Asian and Black children were significantly more likely to have a food allergy compared to their white counterparts (Gupta et al., 2011, p. e12). Another study found that Black and Hispanic children have higher rates of corn, shellfish, and fish allergies than white children do, along with higher rates of asthma and eczema (Mahdavinia et al., 2017, p. 355). Despite these findings, I found some conflicting reports in my research about whether Asian and Hispanic children are consistently more at risk for all severe food allergies than white children (Keet et al., 2014). However, multiple studies corroborated the fact that Black children are the most at risk for food allergies and poor food allergy-related health outcomes (Kumar et al., 2011; Keet et al., 2014).


While Black children report having food allergies at a rate twice as high as their white peers, they are significantly less likely to have their food allergies formally diagnosed (Keet et al., 2014; Gupta et al., 2011). This finding highlights the barriers to healthcare and equal treatment that many Black children may face, as they are less likely to see an allergist or be properly diagnosed by one (Gupta et al., 2011). One study found that when Black children do see allergists, their visits are significantly shorter than their white counterparts, and this gap in healthcare only worsens when they are insured through Medicaid (Mahdavinia et al., 2017, p. 355). Sadly, it is well-documented that minorities in the US are at a higher risk for receiving lower-quality healthcare in general, with Black people being the most likely to receive poorer hospital care (Fiscella et al., 2000, p. 2580). Socioeconomic status also plays a role in healthcare disparities, as people who have a lower socioeconomic status and are a racial minority have the highest risk of poorer health outcomes and a lower quality of care, regardless of whether they have insurance (Fiscella et al., 2000, p. 2579). This disparity accounts for why Black children insured through Medicaid have the shortest visits with their allergists and are typically subjected to the most discrimination by healthcare providers (Fiscella et al., 2000). So not only do Black children have higher rates of food allergies, but they receive lower quality healthcare and treatment for them as well.


There is a need for more research to be done on this topic. I could only find a handful of scholarly articles addressing the racial differences in food allergies and their treatment. None of them called for solutions or provided action plans for healthcare providers, hospitals, or governments to follow. As someone who calls myself a food allergy advocate, I am a bit ashamed that I didn’t know this information. I was under the impression that food allergies were evenly distributed amongst all races/ethnicities and naively expected all children with food allergies to receive the same treatment. When I take a step back and look at my own life, I can clearly see all the ways I have benefited from my white privilege and viewed my experience with food allergies as the default. I can see now how some of the advice I have given about managing food allergies has come from my privileged position in society without an understanding of the structural racism in place that prevents other people from receiving the same access to care.


I follow hundreds of food allergy bloggers and families on social media and am proud to be a voice in the food allergy community. I am constantly learning new things from them and am in awe of their strength and determination. But, when I look at the food allergy advocates that I follow, only a handful of them are Black and people of color, which concerns me given all the research I found that demonstrates the higher prevalence of food allergies among minorities. If anyone has BIPOC food allergy advocates they recommend that I follow, please leave me a comment or you can always message me on my Instagram @tsoyum. A couple of people that I want to shout out include @elijahsecho and @fateinitiative on Instagram. They both continue to do amazing work, spread awareness, and make changes to protect those with food allergies.


I hope you have found this post useful and informative. All people with food allergies deserve the same access to healthcare, proper treatment, and resources. Moving forward, I plan on making it a personal mission of mine to educate others on this racial disparity and help lift up more BIPOC voices within the food allergy community. If you are a non-Black person, I encourage you to reflect on your privilege, educate yourself, and consider donating to a fund like the Minnesota Freedom Fund (www.minnesotafreedomfund.org/donate). Here is an extensive document that includes ways we can help and demand justice (https://docs.google.com/document/d/1-0KC83vYfVQ-2freQveH43PWxuab2uWDEGolzrNoIks/mobilebasic).


References

Fiscella K., Franks P., Gold M.R., Clancy C.M. (2000). Inequality in Quality: Addressing Socioeconomic, Racial, and Ethnic Disparities in Health Care. JAMA, 283(19), 2579–2584. doi:10.1001/jama.283.19.2579

Gupta, R. S., Springston, E. E., Warrier, M. R., Smith, B., Kumar, R., Pongracic, J., & Holl, J. L. (2011). The prevalence, severity, and distribution of childhood food allergy in the United States. Pediatrics, 128(1), e9–e17. https://doi.org/10.1542/peds.2011-0204

Keet, C. A., Savage, J. H., Seopaul, S., Peng, R. D., Wood, R. A., & Matsui, E. C. (2014). Temporal trends and racial/ethnic disparity in self-reported pediatric food allergy in the United States. Annals of Allergy, Asthma & Immunology, 112(3), 222-229.e3. https://doi.org/10.1016/j.anai.2013.12.007

Kumar, R., Tsai, H. J., Hong, X., Liu, X., Wang, G., Pearson, C., Ortiz, K., Fu, M., Pongracic, J. A., Bauchner, H., & Wang, X. (2011). Race, ancestry, and development of food-allergen sensitization in early childhood. Pediatrics, 128(4), e821–e829. https://doi.org/10.1542/peds.2011-0691

Mahdavinia, M., Fox, S. R., Smith, B. M., James, C., Palmisano, E. L., Mohammed, A., Zahid, Z., Assa'ad, A. H., Tobin, M. C., & Gupta, R. S. (2017). Racial Differences in Food Allergy Phenotype and Health Care Utilization among US Children. The journal of allergy and clinical immunology. In practice, 5(2), 352–357.e1. https://doi.org/10.1016/j.jaip.2016.10.006

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