Socioeconomic, Racial Disparities Linked to Food Allergy Resolution

A multicenter cohort study of 1359 children with food allergy found resolution rates varying sharply by allergen, from 35% for milk to 3.8% for peanut, with socioeconomic disadvantage, lower parental health literacy, and racial and ethnic disparities associated with lower odds of resolution.¹

The findings come from FORWARD, a multicenter observational registry enrolling children aged ≤12 years with an IgE-mediated food allergy across multiple US sites.¹ Prior cohort work established broad patterns, showing milk, egg, and wheat allergies tend to resolve, while peanut, tree nut, shellfish, and fish allergies tend to persist, without clarifying which patient and family-level factors drive resolution within a given allergen. The new analysis is among the largest to model socioeconomic and demographic predictors of food allergy resolution directly.

"This data gives us guidance for counseling," investigator Mahboobeh Mahdavinia, MD, PhD, a board-certified allergist/immunologist from The University of Texas Health Science Center at Houston, told HCPLive. "When a child tests positive for egg allergy, there is always a but, meaning we can try to resolve it, and most likely the child will not grow up with an egg allergy. When it is peanut, it is a different conversation."

Food Allergy Resolution Rates by Allergen in FORWARD

FORWARD enrolled 1359 children with physician-diagnosed IgE-mediated food allergy, using caregiver surveys collected at enrollment alongside electronic health record data.¹ Investigators compared demographic and clinical characteristics between children who reported resolution of ≥ 1 food allergy and those who did not, then built multivariable logistic regression models adjusting for race and ethnicity, household income, parental health literacy scores (HLS), and area deprivation index (ADI).¹

Resolution rates diverged widely by allergen. Milk allergy resolved in 35% of children, soy in 32%, and wheat in 27%, while peanut allergy resolved in only 3.8% and shellfish allergy in 3.5%.¹ Mahdavinia attributed the gap to a combination of biology and management practice.

She explained that milk and egg proteins break down more readily with heat, enabling graded oral introduction through home-based "ladder" desensitization protocols. Both milk and egg are harder to eliminate entirely from a household, creating incidental low-level exposure; this is less likely to happen with peanut, tree nut, shellfish, or fish. She also said that the age of allergen introduction, rather than the age of allergy onset, may also shape the likelihood of eventual resolution.

Socioeconomic and Racial Disparities in Food Allergy Resolution

White children reported resolution of food allergy more frequently than Black and Hispanic children across all common allergens studied.¹

“I don't think they're biologically different,” Mahdavinia said. “Honestly, the more and more we do research, [the more the] human race is just one race. Race…is just a social construct.”

In adjusted models, children who did not resolve any of the 9 common food or food-group allergies were more likely to come from families with lower household income, lower parental HLS, and higher ADI, a composite measure of neighborhood-level socioeconomic disadvantage.¹ The study reported that socioeconomic disadvantage, parental health literacy, and racial and ethnic disparities were independently associated with a lower likelihood of food allergy resolution in this cohort.¹

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. Derman C. Race, Income, and Health Literacy Tied to Food Allergy Resolution. HCPLive. Published August 17, 2026. Accessed August 27, 2026. https://www.hcplive.com/view/race-income-health-literacy-food-allergy-resolution