Black and Hispanic/Latino adult patients with food allergies (FAs) less frequently recognize anaphylaxis symptoms and have less interaction with health care providers regarding their food allergy compared with White patients, according to study findings published in the Annals of Allergy, Asthma & Immunology.
Investigators examined differences in care, knowledge, and FA prevalence among a nationally representative sample of US adults with self-reported food allergies. Data was collected by a market research agency from June 2022 to July 2022 via a cross-sectional online survey. Primary outcome measures were FA frequency, recognition of anaphylaxis symptoms, and epinephrine autoinjector (EAI) access by race/ethnicity, insurance type, and geographic region.
The analysis included 1006 survey respondents who were English-speaking adults with convincing FA symptoms (60.9% White, 16.4% Black, 15.5% Hispanic/Latino, 7.2% Asian, Native American, or other; 61.23% female; mean age, 41 years; 41% from the Southern US). With respect to reported education levels, 23% completed high school and about 40% had at least a 4-year university education; with respect to insurance, roughly 12.9% had no insurance, 36.6% had public insurance, and 50.6% had private insurance.
Black and Hispanic/Latino respondents identified fewer symptoms of anaphylaxis overall and were less likely to identify key respiratory symptoms, such as shortness of breath and trouble breathing, as compared to their White counterparts.
The investigators found FA rates to common allergens differed by race/ethnicity. Black vs White/other participants had higher rates of peanut allergy (50.61% vs 35.50% or 38.89%; P <.001) and tree nut allergy (45.73% vs 34.81% or 33.33%; P =.03). Insurance status and race/ethnicity were predictors of anaphylaxis knowledge, with uninsured vs privately insured participants recognizing 8% fewer symptoms (P =.02), and Black and Hispanic/Latino participants vs White participants identifying 8% fewer symptoms (P <.0001 and P =.006), respectively.
Compared with privately insured respondents, lower odds of EAI prescriptions were seen in uninsured participants (odds ratio [OR], 0.24; P <.0001) and publicly insured participants (OR, 0.63; P =.0009). Compared with White and privately insured participants, odds of allergist-diagnosed FA were lower among Black participants (OR, 0.69; P =.06), uninsured participants (OR, 0.41; P =.0003), and publicly insured participants (OR, 0.69; P =.01).
Study limitations include the exclusion of non-English speaking individuals; the lack of FA confirmation by an allergist, making survey responses subject to misclassification bias; and the use of an “other” category that included people from multiple racial/ethnic backgrounds.
“These findings provide important insights into potential drivers of the well-documented racial disparities in FA outcomes within the US,” the study authors concluded. One of the most notable findings was that “Black and Hispanic/Latino respondents identified fewer symptoms of anaphylaxis overall and were less likely to identify key respiratory symptoms, such as shortness of breath and trouble breathing, as compared to their White counterparts.”
Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
