Access to Allergen-Free Food Among Black and White Children with Food Allergy in the FORWARD Study

Background: Racial differences in access to allergen-free food have not been fully described among children with food allergy (FA). Objective: To examine access to allergen-free foods among Black and White children with FA. Methods: Black and White children with FA were enrolled in Food Allergy Outcomes Related to White and African American Racial Differences (FORWARD), a multisite prospective cohort study at 4 urban US centers. Caregivers completed questionnaires regarding access to allergen-free foods. Univariable statistics described demographics. Bivariable statistics evaluated crude associations with access to allergen-free foods. Multivariable logistic regression evaluated the adjusted effect of race on access to allergen-free foods. Geospatial analyses examined the distribution of race, socioeconomic status, and food desert residence. Results: Among participants (n = 336), White caregivers (88.1%) were more likely to report access to allergen-free foods than Black caregivers (59%) (P <.001). White caregivers were more likely to purchase allergen-free foods online (35.2%) than Black caregivers (12%) (P <.001). Although Black children were more likely to live in a food desert, access to allergen-free food was not related to food desert residence. In the unadjusted analysis, White children were 5.2 times as likely to have access than Black children (P <.001); after adjusting for demographics, this increase in access was no longer significant (P =.08). Other predictors of access to allergen-free foods included online food purchasing, annual household income, respondent education level, milk allergy, and child age >5 years. Conclusion: In the FORWARD cohort, Black children have less access to allergen-free foods than White children, but much of the difference is accounted for by socioeconomic status and other participant characteristics.