Racial Gap in Food Allergy Resolution Traced to Access, Not Biology

White children reported resolution of food allergy more frequently than Black and Hispanic children across all common allergens in the FORWARD cohort, including peanut, milk, wheat, soy, and shellfish. Lower household income, lower parental health literacy, and higher area deprivation index (ADI) were independently associated with lower odds of resolution.^1,2

The finding is part of a broader analysis of FORWARD, a multicenter registry enrolling children aged ≥ 12 years with physician-diagnosed IgE-mediated food allergy at sites across the US.¹ Investigators used multivariable logistic regression to model resolution against race and ethnicity, household income, parental health literacy scores (HLS), and ADI, a block-group-level measure of socioeconomic deprivation.¹ In an interview with HCPLive, investigator Mahboobeh Mahdavinia, MD, from the McGovern Medical School at UT Health Houston, said the pattern reflects unequal access to care rather than biological differences between racial groups.

"The more research we do, [we see] human race is just 1 race,” she said. “Race, as we speak about it, is a social construct, and the differences we see are all about access [and] socioeconomy, factors we can provide and manage which impact health."

Why Parent-Reported Data May Undercount Resolution

Mahdavinia said part of the disparity reflects discovery of resolution rather than a true difference in biology. This analysis relied on parent-reported data collected at enrollment, and families without regular follow-up may not know a food allergy has resolved unless a clinician rechecks IgE levels or offers an oral food challenge.¹ Families with closer follow-up, particularly those enrolled in structured graded oral introduction protocols known as allergy ladders, are more likely to have documented resolution.

Mahdavinia said her group is presenting an abstract at the 2026 American Academy of Allergy, Asthma & Immunology (AAAAI) annual meeting on ladder outcomes, reporting 0 anaphylaxis events and most children on ladder protocols tolerating baked or cooked forms of egg and milk. Parents in these families can report resolution with confidence, she said, while parents without comparable access to specialist care and structured protocols have no equivalent information to report.

A second, prospective phase of the FORWARD series will incorporate direct food challenges rather than parent reports alone, Mahdavinia said. This will provide real-time confirmation of resolution independent of family access to follow-up care.

Area Deprivation Index Explains the Racial Signal

When Mahdavinia's team examined race as an initial signal, they modeled ADI to test whether the pattern reflected a demographic factor or a social one. ADI is a validated composite measure of socioeconomic deprivation calculated at the census block-group level, a finer geographic unit than zip code. Higher ADI describes a residential area with less economic and social investment, and it was independently associated with lower odds of food allergy resolution in adjusted models.¹

Mahdavinia said living in a higher-ADI area limits a family's ability to purchase specialized allergen-containing foods used for graded introduction, restricts access to structured cooking and baking approaches, and reduces access to routine allergy follow-up visits. Household income functioned as a second, independent metric in the same models and pointed toward the same conclusion.

“[These findings] validate that it’s not biologic,” she said. “It's really how the environment around that child is to help them resolve the food.”

Watch part 1 of our interview with Mahdavinia here: Socioeconomic, Racial Disparities Linked to Food Allergy Resolution

Editor’s note: Reported disclosures for Mahdavinia include Eli Lilly and Company, GENZYME CORPORATION, Blueprint Medicines Corporation, Regeneron Healthcare Solutions, AstraZeneca Pharmaceuticals LP, Takeda Pharmaceuticals U.S.A., Inc., Grifols USA, CSL Behring, Pharming Healthcare, Inc., Novartis Pharmaceuticals Corporation, and Paratek Pharmaceuticals.

References

1. Dileep A, Bilaver LA, Warren C, et al. Factors associated with outgrowing food allergies: insights from a large food allergy cohort. Ann Allergy Asthma Immunol. Published online August 12, 2026. doi:10.1016/j.anai.2026.08.004

2. Race, income, and health literacy tied to food allergy resolution. HCPLive. https://www.hcplive.com/view/race-income-health-literacy-food-allergy-resolution