Awareness of oral immunotherapy for food allergy varies by race, ethnicity
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Key takeaways:
- 76.7% of non-Hispanic Black respondents had never heard of oral immunotherapy before the survey.
- 51% of respondents said their child was not on oral immunotherapy because they had never heard of it.
Caregivers of children with food allergy among minoritized racial and ethnic groups were less familiar with oral immunotherapy than caregivers of non-Hispanic white children with food allergy, according to a recent study.
These disparities persisted even after adjusting for household income, Megan Bannon, MD, fellow physician, division of allergy and immunology, Cincinnati Children’s Hospital Medical Center, and colleagues wrote in Annals of Allergy, Asthma & Immunology.
The researchers surveyed 293 caregivers of children aged younger than 12 years with food allergy enrolled in the Food Allergy Outcomes Related to White and African American Racial Differences, or FORWARD, cohort between July 2021 and October 2023.
The children included 196 (67%) who were non-Hispanic white, 81 (28%) who were non-Hispanic Black and 16 (5%) who were Hispanic or Latino. Average ages at enrollment in the study included 5.7 years overall, 7.1 years for non-Hispanic Black children, 5.2 years for non-Hispanic white children and 5.8 years for Hispanic and Latino children (P < .001).
Overall, 72 respondents (24.6%) said they were not familiar with OIT. Specifically, 54.3% of non-Hispanic Black respondents, 62.5% of Hispanic and Latino respondents and 9.2% of non-Hispanic white respondents said they were not familiar with OIT (P < .001).
Twenty-nine of the non-Hispanic white respondents (14.8%) had started OIT, but none of the non-Hispanic Black or Hispanic and Latino respondents had started the therapy (P < .001).
The respondents who said they were not familiar with OIT or slightly familiar with OIT included 64 (52.5%) who said they were very interested or somewhat interested in learning about it as an option for treatment.
Percentages of respondents who said they were unsure about or not interested in learning about OIT included 60% of non-Hispanic Black caregivers, 45.5% of Hispanic or Latino caregivers and 33.3% of white caregivers (P = .019).
These caregivers requested information about OIT risks and adverse events (62.1%), how it works (60.5%), instructions and protocols for using OIT including the dosing schedule (54%) and benefits and expected outcomes (50%).
The respondents who were familiar with OIT included 120 (71%) who were very or somewhat confident they had enough information about the treatment to make an informed decision.
Caregivers who said they were interested in or unsure about exploring OIT said they had not started it yet because they had never heard of it before (51%), their health care provider had not discussed it with them (47.1%) or their child had multiple food allergies (13.5%).
Respondents who had never heard of OIT before the survey included 76.7% of non-Hispanic Black caregivers, 50% of Hispanic and Latino caregivers and 26.7% of white caregivers (P < .001).
Additionally, 55.6% of non-Hispanic white caregivers, 50% of Hispanic and Latino caregivers and 25.6% of non-Hispanic Black caregivers said their health care providers had never discussed OIT with them (P = .015).
Outcomes that respondents who had not yet initiated OIT for their children said would make OIT worthwhile to pursue included protection against accidental allergen exposures (63.1%), enabling the consumption of large amounts of the allergen (56.1%) and reducing the frequency of epinephrine autoinjector use for food allergy reactions (41.3%).
The most important factors in deciding to begin OIT included the potential benefits on quality of life such as less worry about accidental allergen ingestion (27.1%), recommendations from the doctor (19.7%) and the doctor’s OIT experience and training (17.6%).
After adjusting for household income, odds ratios in a logistic regression model for familiarity with OIT included 0.1 (95% CI, 0.1-0.4) for non-Hispanic Black respondents and 0.1 (95% CI, 0.0-0.3) for Hispanic and Latino respondents compared with white respondents.
This model also found that households earning more than $200,000 were 7.5 times more likely to be familiar with OIT (95% CI, 1.8-31.2) and households making between $100,000 and $200,000 were 1.6 times more likely to be familiar with OIT (95% CI, 0.6-4) than households earning less than $100,000.
Respondents with children who had a peanut allergy were 9.2 times more likely to be familiar with OIT (95% CI, 1.8-46.7) than respondents whose children were allergic to foods other than peanut.
Considering the costs and time involved with OIT, the researchers said they were not surprised by the correlations between higher household incomes and greater familiarity with the treatment.
The researchers also noted that the persistent disparities in awareness between the groups after adjusting for income may be due to a lack of equitable dissemination of information about OIT, since caregivers reported feeling very or somewhat confident that they had enough information to decide once they were familiarized with the treatment.
Although these factors were not studied, the researchers suggested that clinic time, resource limitations or biases among OIT providers — such as consciously or unconsciously disqualifying patients from treatment due to their race, ethnicity, language or insurance — may contribute to these inequities in information dissemination.
The researchers further indicated that the provider factors associated with discussion and initiation of OIT and how they interact with key patient and caregiver characteristics could be studied in the future, in addition to how caregiver attitudes toward OIT differ among racial and ethnic groups possibly because of low health literacy or medical mistrust.
Perspective
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These significant findings align with broader trends in health care access, where higher socioeconomic status correlates with increased awareness and utilization of newer medical interventions. OIT follows a similar pattern, as found in our 2021 study. However, the extent of this gap, which persists regardless of income in Black and Latino communities, is not just significant, it’s alarming.
The fact that these racial inequities persist in 2024 highlight a call to action for ensuring that all children, regardless of background, have equitable access to advancements in food allergy management and treatment. Not knowing about available treatments means no access to that innovation. This must change.
These findings also closely mirror our experience with the FARE Neighborhoods Initiative. We have seen firsthand that families in marginalized communities often have less access not only to treatment options, but even basic food allergy management information and resources. However, we also have seen the power of community leaders and trusted education in minimizing access gaps and increasing allergists visits, which was presented at this year’s American College of Allergy Asthma & Immunology Annual Meeting.
Collaborating with trusted messengers and meeting people where they are with education and care can make a world of difference in the outcomes of individuals living with diseases such as food allergies. This positive example should encourage us to replicate these community-based efforts.
Mitigating these differences will take a collective approach. No one group can do it alone. Collaborative efforts between patient advocacy groups, community health workers, primary care physicians and allergists are critical to addressing knowledge gaps in food allergy management and treatment. This point is especially true given the health care coverage gaps for allergist visits for patients on Medicaid.
Patients cannot wait for years to learn how to recognize and respond to anaphylaxis or about treatment options that could positively impact their quality of life. We must proactively discuss management and treatment options with all patients using plain language and culturally competent food allergy treatment information delivered by health care providers and other trusted health educators to lessen the existing access gaps.
On a policy level, addressing health disparities requires comprehensive efforts that make care more affordable and attainable. Health insurance, including Medicaid, must offer better coverage of allergist visits and subsequent treatment, removing financial barriers for low-income families. Additionally, federal funding should be allocated to support national and local public service announcements and education campaigns across all communities, ensuring equitable access to food allergy information.
Efforts such as the FARE Neighborhoods Initiative that include community health workers in disseminating multi-language food allergy education through various platforms and with peer-to-peer support can be pivotal in reaching families often overlooked in the health care system.
References:
Chen J, et al. Health Affairs. 2010;29(8):1500-1508.
Ho FO, et al. Am J Manag Care. 2024;doi:10.37765/ajmc.2024.89588.
Warren CM, et al. J Allergy Clin Immunol Pract. 2021;doi:10.1016/j.jaip.2021.07.020.
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