Understanding the experiences of South Asian adults’ management of food allergy

Background: Population studies suggest lower food allergy (FA) prevalence in South Asia however, migration to urbanised, Western environments is associated with higher risk of FA among South Asians (SAs), highlighting the role of environmental and sociocultural factors. Data indicates disproportionate clinical burden for SA compared to White populations, independent of age, sex and area-level deprivation. Despite this, the day-to-day experiences of SA adults managing FA remain under-studied. <br/><br/>Objective: This qualitative study addresses these gaps by exploring the lived experiences of SA adults with FA.<br/><br/>Methods: SA patients aged ≥16yrs formally diagnosed with FA were recruited via a regional allergy service, adverts shared by allergy patient organisations, and posters in places of worship. Individual interviews were conducted, transcribed verbatim and analysed inductively using reflective thematic analysis.<br/><br/>Results: Twenty-seven participants were interviewed from a broad spectrum of socioeconomic status (52% British Indian, 44% British Pakistani, 4% Bangladeshi; 59% women, median age 22 years, interquartile range 20-32 years). Our analysis generated four interlinked themes i) adjustment which involved pragmatic acceptance alongside risky workarounds, ii) socialising particularly regarding hospitality, stigma, and the restaurant problem, iii) support from friends and family which suggested an asymmetric allyship, and iv) acculturation which enforced “keeping face,” deference, and concealment amongst participants. <br/><br/>Conclusion: The findings move beyond a generic education deficit narrative to show where and how culture, language, and social norms intersect with allergy safety. Co-produced, culturally responsive tools delivered across clinics, communities, and small businesses may offer a plausible route to closing the gap between knowledge and safe practice.<br/><br/>Clinical implications: Culturally tailored allergy management is essential for SAs, integrating language, family, and cultural values to enhance education, engagement, adherence, and prompt epinephrine use, improving safety and therapeutic outcomes.<br/>