Kate Johnson

November 12, 2015

SAN ANTONIO — There is a difference in the patterns of food allergy between Asian Indian children living in the United States and white children, according to the first large-scale survey of food-allergic reactions in this population.

"There is a significant food-allergy burden in the Asian Indian population, so we need to make sure that we're addressing allergies unique to their ethnic diet," said investigator Opal Kamdar, MD, a third-year resident at the Northwestern University Feinberg School of Medicine in Chicago.

Dr Kamdar presented results from the Asian Indian Food Allergy Survey, which is still open online, here at the American College of Allergy, Asthma & Immunology 2015 Annual Scientific Meeting.

The list of allergies in the Asian Indian children included the top eight allergens commonly seen in the general population, but there were also some more unusual ones.

The parents of 114 Asian Indian children with food allergies responded to the survey. Mean age at the time of the first allergy diagnosis was 3.3 years, and 66.7% of the children were boys. Respondents reported that 67.5% of the allergies were diagnosed by a doctor, 70.2% were diagnosed with blood or skin tests, and 29.8% were diagnosed with a food challenge.

There were a lot of fruit and vegetable allergies, compared with what we normally see, and these were more common than seafood allergies, which was unusual.

Tree nut, the most common allergy, was seen in 59% of the children. This is "unusual," Dr Kamdar pointed out, because it is not the most common allergy in the general population in the United States. "We think it might possibly be related to the fact that there are a lot of nuts in Indian cooking," she explained.

For instance, some of the Asian Indian children were allergic to besan, which is a chickpea flour, capsicum, which is a variant of green pepper, and Indian lentils, which are used in tur and masoor dals. Other allergens considered unique were avocado, banana, beef, bulgur wheat, coconut, corn, eggplant, food dye, garlic, ginger, green peas, jalapeno peppers, kiwi, melon, rice, and tomato.

"Even with a small number of respondents, we saw a big variety of foods," Dr Kamdar reported. "There were a lot of fruit and vegetable allergies, compared with what we normally see, and these were more common than seafood allergies, which was unusual."

Table. Characteristics of the Food-Allergic Children and Their Families

Characteristic Children, % Parents, % Grandparents, %
Born in India <2.0 50.0 100.0
Food allergy 100.0 11.0 5.4
Asthma 40.0 12.0 3.0
Eczema 68.4 9.3 3.8
Environmental allergy 56.1 38.2 13.2


"There is a general increase in atopic disease in the world," said Dr Kamdar. "The problem is we don't have good prevalence data in India right now to be able to say whether the increase that we're seeing here is migration-related or just a reflection of the worldwide increase."

"There is an increase that we see worldwide, so this fits with the natural history of atopic diseases," said Ellen Sher, MD, an allergist in private practice in Ocean, New Jersey.

However, the allergens reported in this study, "are not that different from what we see in the general population," she explained. "The allergies the investigators considered 'unique' — such as avocado and banana — we see that all the time. The newer things would be the ginger and the jalapeno paper. People just weren't exposed to these things before. It's good to identify these allergens and be aware that they're out there."

"The big thing that's happening now is that people are looking for 'natural' food and new food," added Bruce Prenner, MD, an allergist in private practice in San Diego.

He reported that quinoa and lentil are among the new allergies he is seeing.

Dr Sher pointed out that "seeds are also a big thing now," and added, "I've seen flaxseed allergy lately."

"Providers need to be aware of the possibility of novel food-allergy triggers developing in the population secondary to diverse cuisines," said lead investigator Chitra Dinakar, MD, and allergist and immunologist from Children's Mercy Hospital in Kansas City, Missouri.

"A meticulous history is very important in diagnosing food allergies in the Asian Indian community. Many individuals may be hesitant to reveal the names of suspected food allergens that are specific to their cuisine for fear of losing their credibility or not being understood," she told Medscape Medical News.

Dr Kamdar, Dr Sher, and Dr Prenner have disclosed no relevant financial relationships.

American College of Allergy, Asthma & Immunology (ACAAI) 2015 Annual Scientific Meeting: Abstract 240. Presented November 7, 2015.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.