Most everyone experiences some form of allergy symptoms, from the common dust mite to pet dander and shellfish. Although it is unknown why, the African American population is more likely to have allergies, to be diagnosed with more than one, and to have more severe symptoms.
How do we develop an allergy, identify it and treat it, from a runny nose to a more life-threatening reaction? How are allergies different for black people? Read on to learn more about allergies and what can be done about them.
Development of allergy through sensitization
Allergic sensitization is the first step in the development of allergies. These allergies often start before birth because you are exposed to things that your mother eats or is absorbed from various things around her. After birth, you become sensitized to other common allergens, such as dust mites, food, medications, and insect bites. When you begin to develop symptoms of these allergens largely depends on when you are first exposed to them and how often. The sensitization process begins when your immune system makes specific antibodies to the allergen you encounter, known as immunoglobulin e (IgE). Previously made antibodies are activated when re-exposed to that allergen, causing symptoms.
For example, parents who are feeding their babies solid foods for the first time may not realize that they have developed an allergy. Parents should pay attention to reactions to new foods introduced into their diet. In another example, you may only start sneezing around a friend’s cat, but have no symptoms in dogs. It is possible to be sensitive to the course of one type of pet and not another type of pet.
The most common allergens
Although black Americans are at higher risk of developing and having a more severe reaction to allergies (more on the statistics below), the most common types of allergies are similar across all ethnic groups.
- SeasonalSometimes called hay fever, this allergy gets worse between March and September. The most common symptoms are sneezing, coughing, watery eyes, runny nose and sinus headache. Seasonal allergy symptoms can also trigger an asthma attack.
- The moldDamp environments can lead to mold growth indoors, especially in kitchens and bathrooms, but can happen anywhere with poor ventilation. Not all molds are poisonous, but many can cause allergy symptoms such as sneezing and watery eyes.
- Animal bitesLike seasonal and mold allergies, pet dander can cause respiratory allergy symptoms. They are airborne allergens and can even contribute to dust mites and affect indoor air quality.
- Insect bitesStings and stings are the most likely to cause serious allergies. A life-threatening reaction called anaphylaxis requires immediate medical treatment. Symptoms of shock include a rash or rash, facial swelling, and shortness of breath.
- FoodFoods can cause a variety of allergic reactions, including itchy skin or rash, wheezing, vomiting, and facial swelling. Determining what food allergies you have can be difficult. According to Food Allergy Research & Education, more than 170 foods, such as nuts and dairy products, can cause uncomfortable and life-threatening symptoms.
- MedicinesA side effect is not the same as a drug allergy. An allergic reaction to a drug can cause many symptoms, such as a rash, hives, or fever. More serious reactions may include anaphylaxis and require immediate intervention.
Identifying skin allergy symptoms
It is often easier to detect an allergic reaction on pale skin. Itchy, red, swollen and dry skin is much more visible. These more common signs, however, are not as noticeable on darker skin. If a skin reaction is the only symptom, it may go undiagnosed as an allergy for a long time, often until other symptoms appear. That’s why both patients and their providers need to know how to recognize skin conditions caused by allergies.
- BeehiveThese are round or oval raised bumps that usually occur in an isolated area or, in more severe cases, over a large area. They itch and become more uncomfortable if scratching or tight clothing irritates them.
- AngioedemaThis can occur along with hives or on its own, usually causing severe swelling around the lips, cheeks and eyes. The skin often feels warm to the touch and is more painful than itchy.
- EczemaSome of the classic signs of eczema are the same on dark skin, such as dry, gray and warm skin. You may feel sore. However, the typical redness of eczema on fair skin usually appears purple or gray in black people.
- RashA rash can appear as anything from open sores to a slightly raised and itchy patch of skin. That’s why it’s important to communicate with your provider about any symptoms, any changes in diet or medication, home location or pets, and other experiences.
Testing for severe allergies
If you or your healthcare provider thinks you may have some form of allergy, you will likely be referred to an allergist. An allergist can use several types of tests to determine which foods, dusts, insects, or medications you are allergic to so that you can avoid them.
The allergy skin test is the most common and has been the standard for decades. A small amount of the allergen is injected into your skin through the prick of a tiny needle. The allergist will then wait for a reaction and measure any changes in your skin. A more accurate method is the allergy blood test, which measures the amount of immunoglobulin in your blood to the most common allergens. This blood test can measure the total amount of IgE in your system or test for specific allergens.
Because blacks typically have more than one allergy and reactions can be more severe, allergen avoidance is even more important. For them, testing can help prevent uncomfortable and sometimes life-threatening symptoms.
Allergy treatment options
Treatment options are similar for blacks because the immune system responds similarly. However, treatment doses may vary depending on the severity of your symptoms. You should consult your healthcare provider for guidance on which medications work best for you and how to take them. Most respiratory symptoms can be treated with over-the-counter or commonly prescribed medications.
- AntihistaminesOver-the-counter antihistamines can help relieve allergy symptoms fairly quickly and are available in a variety of forms, including eye drops, tablets, and nasal sprays.
- CorticosteroidsCorticosteroids are used as anti-inflammatories and are available in a variety of forms to treat various allergy symptoms, including skin creams, nasal sprays, and inhalers. They are often prescribed to treat chronic allergy flare-ups.
- DecongestantsThese medications can be used short-term to help relieve acute symptoms during a flare-up. Some people, such as those with high blood pressure, should be careful when choosing decongestants and ask a doctor before using them.
- Allergy shotsIf allergens cannot be avoided and symptoms are difficult to control with the above treatment options, your doctor may recommend allergy shots. These shots are designed to keep your body from overreacting to the allergen when you’re exposed to it, but they don’t work for everyone.
Allergies and black people
Studies have shown that blacks are much more likely than whites to have allergic reactions to pollen, mold, insects, medications, and food. Unfortunately, these studies did not find out why there is such a deep disparity between ethnic groups. Genetics do not appear to be the main reason for the stark contrast in numbers, so more studies are needed to understand why the black population is at higher risk of allergic reactions, especially in severe cases that require medical intervention.
At the 2017 annual meeting of the American Academy of Allergy, Asthma, and Immunology, a group of doctors presented startling new data on the death rate of children with asthma. A closer look at the demographics and other details of more than 2,500 cases revealed that many children had much more severe cases of asthma because they did not receive quality medical care. However, environmental pollution can trigger asthma, which often plagues low-income communities. Predominantly African-American neighborhoods may be near train stations, power plants, and other places that contribute to air pollution.
A study at Northwestern University’s Center for Food Allergy and Asthma Research found that nearly a quarter of black children had a shellfish allergy, compared to just 3% of white children. These percentages increased only among children over five. Disparities were similar for wheat and soy allergy. Now, keep in mind that meal assistance programs rarely have options for those with food allergies that only help with certain foods or specific brands. Support for local food pantries can be even more limited, relying only on donations from local organizations and residents.
Other common allergens may also pose a greater risk to blacks than the general population. Low-income housing may not be well maintained, leading to mold. Multi-unit housing can make it difficult to manage bug infestations, causing insect bites and potentially severe allergic reactions. And those without adequate health insurance may have access to limited medications, some of which they are allergic to.
Allergy summary
Whether it’s tree nuts or pollen, you don’t have to suffer from allergy symptoms just because of your racial identity. More studies are currently underway to find out why allergies disproportionately affect black people. While it’s not clear whether it’s family history or environmental factors, it’s clear that ethnicity can put you at higher risk for both symptoms and severity. If you experience allergy symptoms, contact a medical provider immediately for guidance. They can refer you to an allergist who can test you for the most common allergens, helping you avoid and adequately treat them.