TOPLINE: 

Black patients evaluated for food allergy had higher levels of specific immunoglobulin E (sIgE) but received oral food challenge tests (OFCs) at a significantly lower rate than White patients. When challenged, Black patients had higher rates of passing OFCs, suggesting possible overdiagnosis.

METHODOLOGY:

• Researchers conducted a retrospective study to assess whether the use and outcomes of diagnostic tests for food allergies — OFC tests, skin prick tests, and sIgE tests — vary by race.
• They analyzed 6251 patients evaluated for food allergy at a single center, including new and return visits; of these, 537 were included in the analysis of sIgE (mean age, 11.0 years; 53.3% male), 361 in the analysis of skin prick tests (mean age, 10.3 years; 54.6% male), and 1029 in the analysis of OFCs (mean age, 7.6 years; 55.8% male).
• OFC outcomes were labeled as “reacted” if cetirizine, diphenhydramine, or epinephrine was administered and as “tolerated” if no medication was given.
• Data on allergens were collected for peanuts, eggs, cow’s milk, and tree nuts.

TAKEAWAY:

• Compared with White patients, Black patients had higher mean levels of sIgE for tree nuts (12.0 ng/mL vs 8.4 ng/mL) and all food allergens combined (14.8 ng/mL vs 13.8 ng/mL; P < .001 for both).
• Despite higher mean values of sIgE, Black patients received an OFC test at a significantly lower rate than White patients (2.2% vs 4.8%; P < .001),
• They also had higher rates of tolerating an OFC (90.6% vs 85.7%; P =. 02) and experienced less severe symptoms during challenges.
• Among 117 patients with an outcome for OFC and available results for sIgE, skin prick test, or both, those who “reacted” had higher mean levels of sIgE and larger skin prick test wheal and flare diameters than those who “tolerated” the OFC (P < .05 for all).

IN PRACTICE:

“Given the higher mean sIgE values for Black patients, there is the potential that many Black patients that could tolerate and benefit from OFCs are not completing them. This underscores the need to better understand how social, environmental, and clinical factors intersect to influence sIgE interpretation while also indicating that current diagnostic thresholds may not perform equally across all patient populations,” the study authors wrote. 

SOURCE:

Christina E. Ciaccio, MD, MSc, with the University of Chicago, was the corresponding author of the study, which was published online April 21 in the Annals of Allergy, Asthma & Immunology. Lead author was Luke Detlor, BS, from the University of Chicago’s Pritzker School of Medicine. 

LIMITATIONS: 

The retrospective design limited the ability to assess individual reasons behind differences in OFC use, and researchers could not determine whether OFCs were offered at different rates by race. The analysis at the allergen level was constrained by limited sample size, particularly for matching OFC outcomes with allergen-specific sIgE or skin prick test results. 

DISCLOSURES:

No funding source was mentioned in the study, and no potential conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.