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

项目摘要/摘要 背景：食物过敏(FA)是一种潜在威胁生命的疾病，估计影响8%的 美国的儿童。尽管非裔美国人(AA)和白人儿童在 其他特应性疾病的患病率和严重程度，如哮喘和湿疹，已经被很好地描述了，很少 都知道足总存在这样的差异。有限的现有文献表明，再生障碍性贫血儿童可能有 较差的临床结果，包括与FA相关的致命过敏反应和与FA相关的急诊室 (ED)访问，而不是他们的白人同龄人。表型和内型差异，包括敏感率和 再生障碍性贫血儿童和白人儿童之间的共病正在开始接受检查。关于FA的种族差异的数据 管理实践并不完整；初步数据显示，AA家庭在以下方面的支出明显减少 无过敏原的食物和FA药物比白人家庭更好。照顾有足总经验的儿童的家庭 严重的心理社会结果障碍，包括与FA相关的生活质量(FAQOL)；然而，这些 数据主要来自白人私人保险家庭，人们对这些家庭的心理社会后果知之甚少。 AA家庭。最近的两篇综述得出的结论是，现有的检查FA种族差异的研究太过 在方法上受到限制，无法得出明确的结论，主要是因为依赖FA诊断的自我报告 和横截面设计。 具体目标和方法：我们的目标是对600名AA和白人儿童(0-12岁)进行前瞻性研究 年)，以便：1)确定再生障碍性贫血和白人患者之间临床FA结局的变异性 通过每两个月一次的远程评估、一年两次的诊所访问和两年期间的病历审查；2) 用特异性抗体检测再生障碍性贫血和白种儿童FA的表型和内型差异 实验室标本采集技术和分析；3)识别AA和White之间的差异 儿童在FA管理实践中的家长报告(例如，避免过敏原和携带肾上腺素)； 4)确定再生障碍性贫血儿童和白人儿童在心理社会FA相关结果上的差异 (例如，与FA相关的生活质量、欺凌、焦虑和担忧)。 假设和预期结果：我们假设与白人儿童相比，再生障碍性贫血儿童将： 更高的食物过敏反应率和FA相关的医疗利用；展示独特的FA 表型和内型；对FA管理知识较差，对预防措施的坚持较差 行为；获得药物和无过敏原食物的机会有限；以及报告更好的生活质量。 对其他研究的意义和影响：确认和进一步表征差异 AA和白人FA儿童之间的合作将提供制定临床指南所需的数据， 优化治疗，建立同时满足再生障碍性贫血儿童和白人儿童需求的卫生政策。

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.