FOOD allergies affect approximately 5.6% of children in the USA and are the leading cause of anaphylaxis among children and adults. Managing food allergies has seen significant advances, including food immunotherapy as an option for desensitisation and preventing severe allergic reactions.
The first FDA-approved food immunotherapy product, Arachis hypogaea (peanut) powder, paved the way for research into immunotherapies for other allergens such as egg, milk, tree nuts, and sesame. However, racial and ethnic disparities exist in food allergy prevalence, diagnosis, treatment, and outcomes. Studies have shown that Black and Hispanic children are more likely to have multiple food allergies and experience more severe complications compared to White children. Food allergies not only impose psychological stress but also financial burdens, especially in marginalised communities. These disparities highlight the importance of targeted interventions to close health equity gaps.
Clinical trials are essential for developing effective therapies, but current food allergy immunotherapy trials predominantly include White participants, with Black and Hispanic groups significantly underrepresented. This lack of diversity in clinical trials limits the generalisability of results, particularly when racial and ethnic groups may exhibit varying responses to treatments due to sociocultural and environmental factors. For example, studies suggest Black children respond differently to asthma medications, underscoring the need for diverse trial populations.
Efforts to improve diversity in clinical trials include the 2022 FDA guidelines, which encourage sponsors to recruit from underrepresented groups. The NIH also mandates that its funded trials include diverse participants to ensure results are broadly applicable. However, data show that non-NIH-funded trials often achieve higher racial diversity, suggesting that industry trials may sometimes be more effective in reaching diverse populations due to their broader recruitment networks.
Increasing representation in clinical trials can help ensure that all populations benefit equitably from food allergy treatments, and fostering diversity in future research should aid in reducing health disparities and ultimately improve health outcomes for all individuals with food allergies.
Katie Wright, EMJ
Reference
Suffian H et al. Racial and Ethnic Representation in Food Allergen Immunotherapy Trial Participants: A Systematic Review. JAMA Netw Open. 2024;7(9):e2432710.
