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

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。尽管黑人、白人和拉丁裔儿童在 哮喘和湿疹等其他特应性疾病的患病率和严重程度已经得到了很好的描述， 人们对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相关的致命过敏反应和FA相关的急诊科就诊率，比他们的白人 同伴们。表型和内型的差异，包括敏感率和共病， 黑人和白人儿童开始接受检查。关于FA管理中的种族差异的数据 实践是不完整的；初步数据表明，黑人家庭在过敏原上的支出显著减少。 免费的食物和FA药物比白人家庭更多。照顾有足总经验的儿童的家庭 心理社会结果严重受损，包括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，对心理社会知之甚少 黑人家庭的结果。在拉丁裔儿童群体中，关于这些结果的数据有限 食物过敏。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，主要是因为依赖于足协的自我报告 诊断和横断面设计。 具体目标和方法：我们的目标是前瞻性地研究1450名黑人、白人和拉丁裔 患有FA的儿童，以便： 1)确定与发育差异有关的临床和社会人口学因素 临床免疫耐受和新的食物过敏的发展； 2)确定在关键发展时期(即， 童年中期；青春期)，通过扩大对患者报告结果的评估，以包括 对以下照顾者报告和患者自我报告结构的二元评估： 心理社会结果和疾病管理(例如，肾上腺素携带和过敏原暴露) 以及饮食行为和营养环境(例如，在家庭和社区)。 3)应用最先进的精密医学识别FA的表型和内型差异 FA患者的多维表型和内源性分型方法。 假设和预期结果：我们假设，与白人儿童相比，黑人儿童 不太可能对食物产生临床免疫耐受，更有可能发生新的食物过敏 在研究期间。我们还假设患者和护理者报告数据之间的一致性 随着儿童年龄的增长，儿童的饮食行为和营养环境将因儿童种族/民族而有所不同。 此外，我们假设白人、黑人、墨西哥裔美国人和波多黎各裔儿童有独特的FA 表型(例如，特定过敏原、症状、反应严重程度)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 黑人、白人和拉丁裔儿童之间的FA将提供发展临床所需的数据 指导方针，优化治疗，建立满足黑人、白人和拉丁裔需求的卫生政策 孩子们。

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.