Identifying gaps: A survey of food allergy knowledge and management in US adults

Food allergy (FA) disproportionately affects communities of color in the United States. However, few studies have evaluated adult-specific disparities in FA.

To explore differences in FA prevalence, knowledge, and care among US adults.

A survey of adults with FA which collected data on self-reported allergens, anaphylaxis knowledge, epinephrine autoinjector (EAI) prescriptions, and health care utilization. Outcomes were compared by race/ethnicity, insurance type, and geographic region.

Among the 1006 survey respondents, FA rates to common allergens differed by race/ethnicity. Higher rates of peanut (50.61%) and tree nut (45.73%) allergies were reported by Black vs White participants (35.50% and 34.81%, respectively) and Other (38.89% and 33.33%, respectively) (P < .001 and P = .03). Race and insurance status emerged as predictors of anaphylaxis knowledge, with Black and Hispanic/Latino participants recognizing 8% fewer anaphylaxis symptoms than White respondents (P < .0001 and P = .006, respectively) and uninsured participants identifying 8% fewer symptoms than privately insured subjects (P = .02). Uninsured and publicly insured subjects had lower odds of EAI prescriptions compared with the privately insured (odds ratio [OR] 0.24, P < .0001 and .63, P = .0009, respectively). Black (OR 0.69, P = .06) and uninsured and publicly insured respondents (OR 0.41, P = .0003 and OR 0.69, P = .01, respectively) had lower odds of allergist-diagnosed FA than their White and privately insured counterparts.

This study demonstrates differences in self-reported food allergens by race/ethnicity and anaphylaxis symptom recognition, EAI access, and FA-related health care utilization by race/ethnicity and insurance status. These findings provide insight into potential drivers of disparities in adult FA and may inform efforts to improve care for vulnerable populations.