Racial and ethnic disparity in allergic diseases in the United States: Example of a large country with a diverse population

Abstract

Some racial and ethnic minorities in the United States are disproportionally affected by allergic diseases such as asthma, food allergies, anaphylaxis, and atopic dermatitis. Reasons for this are complex, involving psychosocial, environmental, and genetic factors. Possible asthma susceptibility genes have been identified in racial/ethnic minorities that are likely modified by epigenetic changes following exposure to environmental factors. Examples of these environmental factors are pollution, stress, and violence, which disproportionally affect poor and urban communities. Hispanics and African Americans in inner-city areas are more frequently exposed to air pollution, poor housing conditions, and indoor allergens compared to Whites. These effects are compounded by a lack of regular health care, language barriers, and low health literacy. African ancestry is associated with increased asthma risk and might contribute to disparities among some Hispanic patients such as Puerto Ricans who have the highest asthma burden. African Americans are especially affected by atopic dermatitis, food allergy, and anaphylaxis-related death due to any cause. In contrast, rates of allergic rhinitis are higher among Whites and Asian Americans. Overcoming these disparities in allergic diseases will require culturally competent interventions aimed at risk factors that disproportionally affect racial/ethnic minorities.