Background: There is paucity of reliable epidemiological data regarding the burden of food allergy in most developing countries, including India. Objective: To provide current estimates of the prevalence and distribution of food allergy among urban and rural school children aged 6–14 years in Delhi and the National Capital Region (NCR) of Khekra in India. Methods: A cross-sectional study was conducted from January 2022 to February 2023 to enroll school children, 6–14 years, from select urban and rural schools in Delhi and NCR. A questionnaire consisting of questions focused on household environment, early life factors, and pediatric food allergy characteristics was administered by a trained medical researcher to collect parent-proxy data. Univariate statistics were used to describe frequencies, percentages, and 95% confidence intervals for survey items. Results: The estimated prevalence of parent-reported food allergy was 0.8% (95% CI: 0.4–1.5; urban: 0.4%, 95% CI: 0.1–1.1; rural: 1.7%, 95% CI: 0.7–3.5). Fruits such as mango (0.3%, 95% CI: 0.1–0.9), strawberry (0.1%, 95% CI: 0.0–0.7), orange (0.1%, 95% CI: 0.0–0.7), and custard apple (0.1%, 95% CI: 0.0–0.7) were reported only by urban children, while rural children reported yogurt (0.6%, 95% CI: 0.1–1.8) and wheat (0.3%, 95% CI: 0.0–1.3). Both groups reported brinjal (also known as eggplant) and banana, 0.1% (95% CI: 0.0–0.7) of urban and 0.3% (95% CI: 0.0–1.3) of rural, respectively. Overall, commonly reported clinical symptoms were diarrhea and/or vomiting (100%, 95% CI: 76.2–100), abdominal pain (88.9%, 95% CI: 58.6–98.8), and rash/itchy skin (66.7%, 95% CI: 34.8–89.6). Among children with parent reported food allergy, 66.7% (95% CI: 34.8–89.6) of food allergies were physician diagnosed, of which 33.3% were diagnosed via history alone (95% CI:7.7–71.4) while 66.7% (95% CI: 28.6–92.3) were confirmed via skin prick test and/or blood test. Conclusion: The overall prevalence of food allergy is very low in Delhi and Khekra, India. Future work should focus on elucidating the complex interplay of early-life, environmental, genetic, and lifestyle factors to understand the reasons for India's low food allergy burden and improve epidemiological clues to prevention for the nations with higher disease burden.
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