title: Racial and ethnic disparity in food allergy in the United States: a systematic review.
abstract: BACKGROUND
  The prevalence of food allergy is rising among US children. Little is known about racial/ethnic disparities in food allergy.
  
  
  OBJECTIVE
  We performed a systematic literature review to understand racial/ethnic disparities in food allergy in the United States.
  
  
  METHODS
  We searched PubMed/MEDLINE, Embase, and Scopus for original data about racial/ethnic disparities in the diagnosis, prevalence, treatment, or clinical course of food allergy or sensitization, with a particular focus on black (African American) race. Articles were analyzed by study methodology, racial/ethnic composition, food allergy definition, outcomes, summary statistic used, and covariate adjustment.
  
  
  RESULTS
  Twenty of 645 identified articles met inclusion criteria. The studies used multiple differing criteria to define food allergy, including self-report, sensitization assessed by serum food-specific IgE to selected foods without corroborating history, discharge codes, clinic chart review, and event-reporting databases. None used oral food challenge. In 12 studies, black persons (primarily children) had significantly increased adjusted odds of food sensitization or significantly higher proportion or odds of food allergy by self-report, discharge codes, or clinic-based chart review than white children. Major differences in study methodology and reporting precluded calculation of a pooled estimate of effect.
  
  
  CONCLUSIONS
  Sparse and methodologically limited data exist about racial/ethnic disparity in food allergy in the United States. Available data lack a common definition for food allergy and use indirect measures of allergy, not food challenge. Although data suggest an increased risk of food sensitization, self-reported allergy, or clinic-based diagnosis of food allergy among black children, no definitive racial/ethnic disparity could be found among currently available studies.
authors.affiliation: Department of Internal Medicine, Division of Allergy and Clinical Immunology, The University of Michigan Medical School and the University of Michigan Health System, Ann Arbor, Mich. Electronic address: mgreenha@med.umich.edu.
authors.forename: Matthew
authors.initials: M
authors.lastname: Greenhawt
authors.affiliation: The Global Food Protection Institute, Battle Creek, Mich.
authors.forename: Christopher
authors.initials: C
authors.lastname: Weiss
authors.affiliation: Taubman Health Sciences Library, University of Michigan, Ann Arbor, Mich.
authors.forename: Marisa L
authors.initials: ML
authors.lastname: Conte
authors.affiliation: Oak Ridge Institute for Science and Education Fellow, Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, Ga.
authors.forename: Marlie
authors.initials: M
authors.lastname: Doucet
authors.affiliation: Human Biology Department, Stanford University, Palo Alto, Calif.
authors.forename: Amy
authors.initials: A
authors.lastname: Engler
authors.affiliation: Department of Emergency Medicine and Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Mass.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D005512:Food Hypersensitivity / Q000453:epidemiology / Q000208:ethnology*; D054624:Health Status Disparities; D006801:Humans; D014481:United States / Q000453:epidemiology
keywords: 95% Predictive Decision Points; African American; Anaphylaxis; Black; Children; Disparity; Epinephrine; Ethnicity; Food allergy; Food sensitization; Prevalence; Race; Serum IgE