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

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。虽然非洲裔美国人（AA）和白色儿童在 其他特应性疾病如哮喘和湿疹的患病率和严重程度已得到很好的描述， 已知FA中的这种差异。有限的现有文献表明，AA儿童可能有 更差的临床结局，包括FA相关致死性速发型过敏反应和FA相关急诊的发生率 (ED)访问，比他们的白色同龄人。表型和内型差异，包括致敏率和 AA和白色儿童之间的共病开始被检查。FA的种族差异数据 管理实践是不完整的;初步数据表明，AA家庭花费显着减少， 不含过敏原的食物和FA药物的比例要比白色家庭高。照顾有FA经验儿童的家庭 心理社会结局的显著损害，包括FA相关生活质量（FAQoL）;然而，这些 数据主要来自白色，私人保险的家庭，很少有人知道的心理社会结果， AA家庭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。 在方法学上受限于得出明确结论，主要是由于依赖于FA诊断的自我报告 和横截面设计。 具体目的和方法：我们的目标是前瞻性研究600名AA和白色儿童（0-12岁 年），以便：1）确定AA和白色患者之间临床FA结局的变异性 通过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） 使用特异性抗体检测AA和白色FA儿童之间的表型和内型差异。 实验室标本采集技术和分析; 3）识别AA和白色之间的差异 按家长报告的FA管理实践中的儿童（例如，避免过敏原和携带肾上腺素）; 和4）确定AA和白色儿童在心理社会FA相关结果方面的差异 (e.g., FA相关的生活质量，欺负，焦虑和担心）通过上述调查方法。 假设和预期结果：我们假设与白色儿童相比，AA儿童将： 食物过敏反应和FA相关医疗保健利用率较高;证明FA独特 表型和内型; FA管理知识较差，预防性治疗依从性较差 行为;获得药物和无过敏原食物的机会有限;并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和白色FA儿童之间的差异将提供制定临床指南所需的数据， 优化治疗，并建立满足AA和白色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.