Children with lower household income, lower parental health literacy, and greater neighborhood-level deprivation were significantly less likely to report resolution of food allergy, according to a FORWARD cohort study.¹
The factors linked to food allergy resolution in children have remained poorly defined despite rising prevalence and the substantial health, psychosocial, and financial burden the diagnosis places on families. According to Food Allergy, Research & Education (FARE), allergies to milk, egg, wheat, and soy often resolve in childhood, whereas allergies to peanuts, tree nuts, and shellfish are often lifelong.2
“Fewer than 20% of children will outgrow their peanut allergy,” said Kirsi Järvinen-Seppo, MD, chief of pediatric allergy and immunology at UR Medicine Golisano Children’s Hospital.3 “That is why peanut remains one of the most researched and carefully managed food allergies in pediatrics.”
The team, led by Mahboobeh Mahdavinia, MD, PhD, from McGovern Medical School at UT Health Houston, drew on caregiver surveys and electronic health record data from FORWARD (Food Allergy Outcomes Related to White and African American Racial Differences), a multicenter observational study, to identify demographic and clinical factors associated with resolution among children with ≥ 1 active food allergy.¹ Participants were allergic to either milk, soy, wheat, peanut, or shellfish.
Food Allergy Resolution Rates in the FORWARD Cohort
The analysis included 1359 participants younger than 12 years with physician-diagnosed IgE-mediated food allergy enrolled in FORWARD. Investigators compared demographic and clinical characteristics between children with and without caregiver-reported resolution of ≥ 1 food allergy at enrollment, then built multivariable logistic regression models evaluating associations between resolution and race/ethnicity, household income, health literacy scores, and area deprivation index (ADI).¹
Resolution rates varied widely by allergen. Milk allergy resolved most often (35%), followed by soy (32%) and wheat (27%). Peanut (3.8%) and shellfish (3.5%) allergies were resolved far less frequently, consistent with the more persistent natural history typically observed for these allergens relative to milk, egg, soy, and wheat.¹
Racial and Socioeconomic Predictors of Resolution
White children reported resolution of food allergy more frequently than Black and Hispanic children across all common food allergens evaluated in the cohort.¹ This pattern held in unadjusted comparisons and persisted after investigators accounted for clinical and demographic covariates in multivariable models.
Lower family income, lower parental health literacy scores, and higher ADI, a composite measure of neighborhood-level socioeconomic disadvantage, were each observed more frequently among children who did not report resolution across all 9 common food and food groups assessed in the study.¹ Because FORWARD is observational and relies on caregiver-reported resolution rather than oral food challenge confirmation in all cases, the findings describe association rather than a mechanism, but the consistency across income, literacy, and geographic deprivation measures points to social determinants of health as a recurring factor in unequal food allergy outcomes.
An earlier analysis from the same research group, presented at the American Academy of Allergy, Asthma & Immunology (AAAAI) 2024 annual meeting in a smaller cohort of 752 children, similarly found white children reported resolution of food allergy more often than Black or Hispanic children and linked higher household income to a greater likelihood of resolution.3 Investigators also reported that allergic rhinitis was associated with outgrowing food allergies (P =.0021).4The newly published FORWARD analysis extends those findings with a larger enrolled cohort and adds parental health literacy and ADI as independent predictors.1
References
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
Abellard A, Alabduljabbar S, Bilaver L, et al. Sociodemographic Factors Associated with Outgrowing Food Allergy in Children. The Journal of Allergy and Clinical Immunology. Published February 2024. https://www.jacionline.org/article/S0091-6749(23)01660-3/fulltext
