How Poverty and Race Impact Allergies: Addressing Disparities in Allergy Care

Allergies are a growing public health concern as climate change impacts the start and length of allergy season, along with an increase in allergies among recent generations. However, not all individuals are affected equally. Research increasingly shows that social determinants of health, such as poverty, race, and access to healthcare, play a role in shaping allergy prevalence, diagnosis, and treatment outcomes. This article explores how these factors intersect with allergies and highlights the need for equitable solutions to address disparities in allergy care.

Poverty is a powerful determinant of health, influencing everything from environmental exposures to access to adequate medical care. For people living in low-income communities, the risk of developing allergies is often heightened due to a combination of environmental, nutritional, and psychological factors.

Substandard housing conditions, which are more common in low-income areas, can increase exposure to allergens such as mold, dust mites, and cockroaches. These allergens are known triggers for asthma and other allergic conditions for both adults and children, and sometimes pets.

Households located in low-income areas have been linked to increased allergen exposure and sensitization, along with higher levels of asthma morbidity and mortality for children. Substandard housing can also be a prime breeding ground for mites, cockroaches, and mold due to excess moisture from lack of proper ventilation. Water leaks, exposure to endotoxins, and inadequate pest control create environments where allergies thrive. It is also common for low-income neighborhoods to be located near areas of large vehicle traffic, which can increase ambient particular matter and fuel fumes, exacerbating allergy and asthma symptoms.¹

Access to nutritious, diversified food is another critical factor influencing allergy risk. Low-income communities often face food insecurity, with limited access to fresh fruits, vegetables, and other foods that support immune health. A diet high in processed foods and low in essential nutrients can weaken the immune system, making individuals more susceptible to allergies and immune dysfunction.^2,3

Chronic stress, which is more prevalent in low-income populations⁴, can also contribute to allergic conditions. Stress has been shown to dysregulate the immune system, increasing inflammation and worsening conditions like asthma and eczema. It also plays a significant role in manifesting and treating allergic disease.⁵ This highlights the need for holistic approaches to allergy management that address both psychological and environmental factors.

Racial and ethnic minorities often face a disproportionate burden of allergic conditions, driven by a combination of genetic, environmental, and systemic factors. Understanding these disparities is essential for developing targeted interventions.

Research has shown that certain populations experience higher rates of asthma and food allergies compared to others. For example, some studies indicate that children from specific economic and racial back grounds are more likely to develop allergies, including food allergies. In a study conducted in 2020, Black children were found to have higher odds of allergies to shellfish and finfish, along with higher rates of asthma than White children from similar backgrounds.⁶ Higher prevalence of asthma has also been found in populations below the poverty threshold, along with more self-reported food allergies in ethnic minority groups.⁷ There has also been an increase in food allergies across the board, with a greater increase in allergies for non-Hispanic Black children.⁸

Implicit bias among healthcare providers can also contribute to disparities in allergy care. After compiling and analyzing 28 studies on implicit bias in the healthcare industry, researchers found evidence that minority patients are often undertreated or misdiagnosed due to unconscious biases. These unconscious biases can also negatively impact patient-provider interactions and treatment decisions. A specific example is that Black patients in the US are significantly more likely to be questioned about smoking than White patients. In four other studies, researchers found a significant correlation between high levels of pro-White implicit bias and treatment responses that favored those patients.¹¹

Addressing implicit bias through training and education is essential for ensuring equitable care for all patients, no matter their background.¹²

Where individuals live can also influence their allergy risk and access to care. Urban and rural environments present unique challenges that must be addressed to reduce disparities.

Urban areas, particularly low-income neighborhoods, are often hotspots for environmental allergens. Air pollution, traffic-related emissions, and high levels of indoor allergens are common in these settings. Urban air pollution exacerbates respiratory allergies and asthma, particularly in children. Addressing these environmental triggers requires targeted policies, such as improving housing quality and reducing air pollution.¹³

While urban areas may have higher levels of environmental allergens, rural areas often face a shortage of healthcare providers, including allergists. This lack of access to specialized care can delay diagnosis and treatment, preventing individuals from receiving the care they need. Children in rural areas are less likely to receive a timely, accurate diagnosis of food allergies compared to their urban counterparts. Expanding telehealth services and increasing the number of allergists in rural areas are potential solutions to this problem.¹⁴

Addressing the impact of poverty and race on allergies requires a multifaceted approach that includes policy changes, community-based interventions, and efforts to improve cultural competence in healthcare.

When discussing how to limit the impact of allergies on low-income and minority communities, it’s important to address the social determinants of health through policy changes that promote health equity. In a study conducted by two contributors at the Henry J. Kaiser Family Foundation, researchers found that by ensuring individuals have access to affordable, high-quality healthcare, disparities between populations can be reduced significantly.¹⁵

Community health initiatives that address housing quality, nutrition, and education about allergies and health management can also make a difference. Community-based asthma interventions have effectively reduced hospitalizations and improved the quality of life for children in low-income communities. Similar programs could be developed to assist other allergic conditions, such as food allergies and eczema.¹⁶

Lastly, training healthcare providers to recognize and confront racial and socioeconomic biases, while addressing disparities, is essential for ensuring equitable treatment. By fostering a healthcare system that is inclusive and responsive to the needs of all patients, we can create a more equitable future for allergy care.¹⁷

While the link between socioeconomic factors and allergy disparities is well-documented, many studies are qualitative, resulting in a notable gap in large-scale quantitative studies that measure how these variables impact allergy outcomes. A review published in 2019 highlights that much of the existing research relies on small cohorts or observational data due to a lack of comprehensive and conclusive research conducted on minority and low-income populations. As presented in this review, while Black and Latino populations make up 30% of the US population, they account for only 6% of all participants in federally funded clinical trials. This same study found that only 2% of government-funded cancer research has focused on minority health needs, and even though Black Americans are one-third more likely to have asthma and over three times more likely to die from complications compared to White Americans, only 5% of federally funded lung disease studies over the past 20 years have been focused on minority groups.¹⁸ This underscores the need for more awareness and understanding of these issues to support equitable care across all populations.

Socioeconomic and racial affiliation are powerful determinants of health that significantly impact allergy prevalence and treatment outcomes. From environmental exposures in low-income housing to systemic barriers in healthcare access, these factors create disparities that must be deal with through target interventions and policy changes. By raising awareness of these issues and advocating for equitable solutions, we can work toward a future where everyone has the opportunity to live a healthy, allergy-free life.