Food Allergy Reaction Severity and Management in a Diverse Population

To evaluate parent-reported allergic reaction severity, lifetime epinephrine use, and emergency department usage in diverse populations of Non-Hispanic white, Non-Hispanic Black (NHB), and Hispanic/Latino children.Children 12 years and younger (n = 784) with a diagnosed food allergy were enrolled from 4 clinical sites (Lurie Children’s, Rush Children’s, Cincinnati Children’s, and Children’s National Hospitals) comprising the Food Allergy Outcomes Related to White and African American Racial Difference study.Data were obtained from the intake survey of the Food Allergy Outcomes Related to White and African American Racial Difference study, a prospective multisite longitudinal cohort study evaluating race, ethnicity, parent reported reaction severity, age of first reaction, and lifetime epinephrine use for each reaction. Mixed effect logistic regression and Poisson models were adjusted for first reaction, sex, age at enrollment, and enrollment site but not for other socioeconomic factors.The authors reported that NHB children had a greater risk of more severe reactions (odds ratio [OR] 1.7; 95% confidence interval [CI]: 1.2–2.3) and emergency department visits (odds ratio: 2.8; CI: 1.4–5.4). Despite these markers of increased reaction severity, NHB children were less likely to receive epinephrine (incident rate ratio 0.4; 95% CI: 0.3–0.5). Similarly, Hispanic/Latino children also had lower lifetime epinephrine utilization (incident rate ratio 0.3; 95% CI: 0.2–0.5).Effective treatment with epinephrine appears underused despite severe food allergic reactions occurring more commonly in historically marginalized populations.This study highlights the importance of educating all patients and their families about exposure prevention and first line treatment of severe allergic reactions. Racial inequities in food allergy management persist. A better understanding of how socioeconomic disparities influence these findings is needed to provide more targeted interventions for at-risk groups.