OBJECTIVES: We compared direct medical costs borne by the health care system and out-of-pocket costs borne by families for children with food allergy by socioeconomic characteristics. METHODS: We analyzed cross-sectional survey data collected between November 2011 and January 2012 from 1643 US caregivers with a food-allergic child. We used a 2-part regression model to estimate mean costs and identified differences by levels of household income and race or ethnicity. RESULTS: Children in the lowest income stratum incurred 2.5 times the amount of emergency department and hospitalization costs as a result of their food allergy than higher-income children ($1021, SE +/-$209, vs $416, SE +/-$94; P < .05). Costs incurred for specialist visits were lower in the lowest income group ($228, SE +/-$21) compared with the highest income group ($311, SE +/-$18; P < .01) as was spending on out-of-pocket medication costs ($117, SE +/- $26, lowest income; $366, SE +/-$44, highest income; P < .001). African American caregivers incurred the lowest amount of direct medical costs and spent the least on out-of-pocket costs, with average adjusted costs of $493 (SE +/-$109) and $395 (SE +/-$452), respectively. CONCLUSIONS: Disparities exist in the economic impact of food allergy based on socioeconomic status. Affordable access to specialty care, medications, and allergen-free foods are critical to keep all food-allergic children safe, regardless of income and race.