Food Allergy Outcomes Related to White and African American Racial Differences (FORWARD)

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PROJECT SUMMARY/ABSTRACT Background: Food allergy (FA) is a potentially life-threatening condition that affects an estimated 8% of children in the United States. Although differences between African American (AA) and White children in the prevalence and severity of other atopic conditions such as asthma and eczema have been well described, little is known about such differences in FA. The limited existing literature indicates that AA children may have worse clinical outcomes, including rates of FA-related fatal anaphylaxis and FA-related emergency department (ED) visits, than their White peers. Phenotypic and endotypic differences, including rates of sensitization and co-morbidities, between AA and White children are beginning to be examined. Data on racial differences in FA management practices are incomplete; preliminary data suggest that AA families spend significantly less on allergen-free foods and FA medications than do White families. Families caring for children with FA experience significant impairments in psychosocial outcomes, including FA-related quality of life (FAQoL); however, these data come primarily from White, privately insured families, and little is known about psychosocial outcomes in AA families. Two recent reviews concluded that existing studies examining racial disparities in FA are far too methodologically limited to draw definitive conclusions, primarily due to reliance on self-report of FA diagnosis and cross-sectional designs. Specific Aims and Methods: Our goal is to prospectively study a cohort of 600 AA and White children (0-12 years) with FA in order to: 1) Determine variability in clinical FA outcomes between AA and White patients via bimonthly remote assessments, biannual clinic visits, and medical chart review over a two-year period; 2) Examine phenotypic and endotypic differences between AA and White children with FA using specific laboratory specimen collection techniques and assays; 3) Identify differences between AA and White children in FA management practices by parent report (e.g. allergen avoidance and epinephrine carriage); and 4) Determine differences between AA and White children in psychosocial FA-related outcomes (e.g., FA-related quality of life, bullying, anxiety, and worry) via the above survey methods. Hypotheses and Expected Results: We hypothesize that compared to White children, AA children will: have higher rates of food-allergic reactions and FA-related healthcare utilization; demonstrate unique FA phenotypes and endotypes; have poorer knowledge of FA management and worse adherence to preventative behaviors; have limited access to medications and allergen-free foods; and report better quality of life. Significance and Effects on Other Research: Confirming and further characterizing differences between AA and White children with FA will provide the data required to develop clinical guidelines, optimize treatment, and build health policies that meet the needs of both AA and White children.