FOOD oral immunotherapy (FOIT) represents a groundbreaking approach to managing food allergies in both children and adults. However, a recent review by Suffian et al. reveals significant racial and ethnic disparities in FOIT clinical trials. Their analysis of 26 randomised clinical trials (RCTs) found that Black and Hispanic/Latinx populations were consistently underrepresented. Such disparities raise concerns about the general applicability of FOIT’s promising results, particularly in populations that bear a disproportionate burden of food allergies.
Clinical guidelines rely on evidence from RCTs, but when trial participants do not reflect the diversity of the intended patient population, findings may lack real-world relevance. Suffian et al. emphasise that despite the enthusiasm for FOIT, current research does not adequately represent the racial and ethnic diversity of the US. Structural issues in recruitment, retention, and classification hinder efforts to achieve representative research samples, leaving patients, researchers, and funders with limited insights into FOIT’s broader applicability.
While many solutions focus on downstream adjustments, such as refining clinical care guidelines and improving recruitment, these do not address the root causes of disparity. True health equity in FOIT research requires tackling the structural and social determinants of health, which are often neglected. Achieving equitable inclusion in trials is costly and complex but vital for ensuring that FOIT results benefit all racial and ethnic groups.
To achieve this, research teams must embrace community-based participatory research and diverse recruitment strategies. Innovations like telemedicine and mobile clinics can also help bridge access gaps for underrepresented groups. Improved clinical reimbursement, unbiased referrals, and prompt specialist access are essential for ensuring equitable access to allergy care, which remains a challenge for many marginalised communities.
Moreover, healthcare institutions must be equipped to provide standard diagnostic and therapeutic options for allergies. Without this, advancements like FOIT will remain out of reach for those who most need them. As one of the most advanced healthcare systems globally, the US must lead the way in health equity, not only in research but in accessible, standardised allergy care. Addressing these upstream barriers will create a foundation for FOIT’s success across all communities, moving towards the equitable healthcare system all patients deserve.
Reference
Hoyt AEW et al. Addressing disparities in food allergen immunotherapy trials. JAMA Netw Open. 2024;7(9):e2432612.
