Assessing Disparities in the Prevalence of Atopic Comorbidities Among Food-Allergic Children

To evaluate the effect of community-level deprivation on the prevalence of atopic comorbidities among children with food allergies (FA).

Children with IgE-mediated FA (n = 700) aged 4 and 12 years enrolled in the prospective multicenter Food Allergy Outcomes Related to White and African American Racial Differences cohort (2 participating sites in Chicago and 1 each in Washington DC and Cincinnati).

Participants were identified as having FA based on clinical IgE-mediated reactions to foods in conjunction with confirmatory testing using positive skin-prick and/or allergen-specific IgE testing. The socioeconomic status for each participant was obtained through the Census Bureau’s annual American Community Survey and stratified into a validated ADI (Area Deprivation Index) related to income, education, employment, and housing quality. A higher ADI was associated with greater socioeconomic disadvantage. The ADI was assessed in relation to other variables including gender, ethnicity and race, presence of a smoker in the house, and comorbid atopy (asthma, eczema, allergic rhinitis) through multiple linear regression analysis.

Independent of race, a higher ADI increased the risk of asthma and allergic rhinitis (AR) but not eczema. The mean ADI of patients with and without asthma was 43.3 vs 31.8 (P < .001) and for AR was 39.1 vs 33.4 (P < .008). In addition, Black children had higher rates of asthma (odds ratio 2.76; 95% confidence interval = 1.77–4.29) and AR (odds ratio 2.5; 95% confidence interval = 0.83–2.52) than white children after adjusting for mean ADI, without any significant differences in regard to eczema. Notably, ADI was much higher in households with a smoker (48.1 vs 32.5, P < .001). Black children were more likely to live with a smoker than white children (21.8% vs 3.2%, P < .001) and household smoking was inversely associated with income (P < .001) and parental education (P < .001).

This study suggests that neighborhood-level socioeconomic disadvantage is associated with higher rates of asthma and AR in children with food allergies. Disease burden of asthma and AR is greater in Black children with food allergy independent of the socioeconomic status of the community.

Across multiple domains, the impact of socioeconomic factors on childhood development is pronounced. This study adds to our understanding that, in addition to individual socioeconomic disadvantage, neighborhood level deprivation is associated with patient-level outcomes in children with food allergy. The authors acknowledge that the effect of ADI on asthma and AR could be linked to indoor air pollutants, which is a reasonable consideration given the strong association of ADI with indoor smoking. Additional linkages with lower income could increase individual-level stress experienced by children with food allergy and create challenges for families in providing allergen-free diets. Children living in socioeconomically deprived settings are also more likely to have greater exposure to indoor allergens such as dust mite and cockroach. This study reminds the clinician that children we care for live in complex worlds, and although important, the medicines and counseling we provide must be coordinated with social supports on the community level to be most effective.