Food Allergy Management and Outcomes Related to Racial/Ethnic Differences from Infancy through Adolescence: The FORWARD Study

项目总结/摘要 背景：食物过敏（FA）是一种潜在的危及生命的疾病， 在美国的孩子们。虽然黑人、白色和拉丁裔儿童在 其它特应性病症如哮喘和湿疹的流行率和严重性已经被很好地描述， 关于FA中的这种差异知之甚少。黑人儿童的临床结果可能更差，包括 FA相关致死性速发型过敏反应和FA相关急诊（艾德）就诊率高于白色人群 同龄人表型和内生型差异，包括致敏率和共病率， 黑人和白色儿童开始接受检查。FA管理中的种族差异数据 实践是不完整的;初步数据表明，黑人家庭在过敏原上的花费要少得多， 免费的食物和FA药物比白色家庭。照顾有FA经验儿童的家庭 心理社会结局显著受损，包括FA相关生活质量（FAQoL）;然而， 这些数据主要来自于白色、私人保险的家庭， 黑人家庭的结果。关于拉丁裔儿童人群中这些结果的数据有限 食物过敏最近的两篇综述得出结论，现有的研究在FA中的种族差异太大了。 在方法上，由于依赖于FA的自我报告，因此无法得出明确的结论 诊断和横断面设计。 具体目标和方法：我们的目标是前瞻性研究1,450名黑人、白色人和拉丁人 患有FA的儿童，以便： 1)确定与发展差异相关的临床和社会人口统计学因素 临床免疫耐受和新的食物过敏的发展; 2)确定关键发育期（即， 儿童中期;青春期），扩大对患者报告结局的评估， 以下患者报告和患者自我报告结构的二元评估： 心理社会结局和疾病管理（例如肾上腺素携带和过敏原暴露） 饮食行为和营养环境（例如在家庭和社区）。 3)通过应用最先进的精准医学来识别FA的表型和内型差异 FA患者的多维表型和内型分析方法。 假设和预期结果：我们假设，与白色儿童相比，黑人儿童 不太可能对食物产生临床免疫耐受，而更可能发生新发食物过敏 在研究期间。我们还假设，患者报告数据和非患者报告数据之间的一致性 随着儿童年龄的增长，饮食行为和营养环境将因儿童种族/民族而异。 此外，我们假设白色、黑色、墨西哥裔美国人和波多黎各儿童具有独特的FA 表型（例如，特异性过敏原、症状、反应严重性）以及独特的FA内型（例如， 高嗜酸性粒细胞FA） 对其他研究的意义和影响：确认和进一步表征差异 在患有FA的黑人、白色和拉丁裔儿童之间的研究将提供开发临床 指导方针，优化治疗，并建立满足黑人，白色和拉丁美洲人需求的卫生政策 孩子

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 Black, White, and Latinx 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. Black 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 Black and White children are beginning to be examined. Data on racial differences in FA management practices are incomplete; preliminary data suggest that Black 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 Black families. There is limited data on these outcomes among the Latinx population of children food allergy. 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 1,450 Black, White, and Latinx children with FA in order to: 1) Determine the clinical and sociodemographic factors associated with differences in the development of clinical immune tolerance and the development of new food allergies; 2) Determine differences in FA management and outcomes during pivotal developmental periods (i.e. middle childhood; adolescence) by expanding assessment of patient-reported outcomes to include dyadic assessment of the following caregiver-reported and patient self-reported constructs: Psychosocial Outcomes and Disease Management (e.g. epinephrine carriage and allergen exposure) and Eating behaviors and nutrition environments (e.g. in the home and community). 3) Identify phenotypic and endotypic differences in FA by applying state-of-the-art precision medicine approaches for multidimensional phenotyping and endotyping of FA patients. Hypotheses and Expected Results: We hypothesize that compared to White children, Black children are less likely to develop clinical immune tolerance to foods and more likely to develop new-onset food allergy during the study period. We also hypothesize that concordance between patient- and caregiver-report data will decrease as children age and eating behaviors and nutrition environment will differ by child race/ethnicity. Additionally, we hypothesize that White, Black, Mexican-American and Puerto-Rican children have unique FA phenotypes (e.g., specific allergens, symptoms, reaction severity) as well as unique FA endotypes (e.g., hyper-eosinophilic FA) Significance and Effects on Other Research: Confirming and further characterizing differences between Black, White, and Latinx children with FA will provide the data required to develop clinical guidelines,optimize treatment, and build health policies that meet the needs of Black, White, and Latinx children.