Food Allergy Reaction Severity and Management in a Diverse Population

Samantha Kay-Green, Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Neil Thivalapill, Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Lucy Bilaver, Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Jialing Jiang, Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Amal Assa'ad, Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio.
Susan Fox, Division of Allergy and Immunology, Department of Medicine and Department of Pediatrics, Rush University Medical Center, Chicago, Ill.
Hemant Sharma, Division of Allergy and Immunology, Children's National Health Systems, Washington, DC.
Mahboobeh Mahdavinia, Division of Allergy and Immunology, Department of Medicine and Department of Pediatrics, Rush University Medical Center, Chicago, Ill.
Linda Herbert, Children's National Medical Center, Washington, DC; George Washington University School of Medicine, Washington, DC.
Christopher Warren, Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill.
Ruchi Gupta, Institute for Public Health and Medicine, Center for Food Allergy and Asthma Research, Northwestern University Feinberg School of Medicine, Chicago, Ill; Department of General Academic Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill. Electronic address: r-gupta@northwestern.edu.

Document Type

Journal Article

Publication Date

3-1-2024

Journal

The journal of allergy and clinical immunology. In practice

Volume

12

Issue

3

DOI

10.1016/j.jaip.2023.12.052

Keywords

Allergic reaction; Food allergy; Health disparities

Abstract

BACKGROUND: Definitive treatment for food allergy reactions including anaphylaxis varies widely by reaction severity and socioeconomic status, but little data exist to characterize the relationship between severity, management, and race and ethnicity. OBJECTIVE: To analyze the differences in reaction severity, epinephrine use, and emergency room (ER) use by race and ethnicity in a large, diverse, food-allergic cohort. METHODS: We analyzed intake data from participants in the Food Allergy Outcomes Related to White and African-American Racial Differences cohort on the history of food allergy reactions, severity of the reactions, and management associated with each reaction. We used descriptive statistics as well as mixed-effects logistic and Poisson models to describe the differences in reaction severity, ER visits, and total lifetime epinephrine use by race and ethnicity. RESULTS: A total of 784 children were included in the analysis: 425 (54.2%) were non-Hispanic White, 282 (36.0%) were non-Hispanic Black, and 77 (9.8%) were Hispanic/Latino. Non-Hispanic Black children had increased odds of more severe reactions (odds ratio, 1.7; 95% CI, 1.2-2.3) and higher odds of going to the ER (odds ratio, 2.8; 95% CI, 1.4-5.4). Both non-Hispanic Black (incidence rate ratio, 0.4; 95% CI, 0.3-0.5) and Hispanic/Latino (incidence rate ratio, 0.3; 95% CI, 0.2-0.5) children had lower rates of total lifetime epinephrine use. CONCLUSIONS: There are significant disparities in the severity and treatment of food allergy reactions by race and ethnicity, resulting in increased ER use and decreased total lifetime epinephrine use. Equipping parents with resources and tools on management of food allergy reactions may result in decreased disparity in access to definitive care.

Department

Psychiatry and Behavioral Sciences

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