Racial and socioeconomic disparities exist in peanut oral immunotherapy

Published: April 29, 2024

Oral immunotherapy (OIT) has emerged as a promising treatment approach recommended by multiple scientific societies for the treatment of food allergy. Prior studies demonstrate significant differences among food allergic individuals across race, ethnicity, and socioeconomic groups. However, disparities in OIT have not yet been evaluated.

This study from Gallagher et al., recently published in The Journal of Allergy and Clinical Immunology: In Practice, identified 1028 peanut allergic patients under 18 years of age receiving care in the University of Michigan food allergy clinics. 148 patients undergoing peanut OIT (treatment group) were compared to the 880 patients avoiding peanut (control group). Sociodemographic characteristics including sex, age, self-reported race and ethnicity, payer status (insurance type), zip code and neighborhood affluence/disadvantage index were obtained for analysis.

There were no differences in gender or ethnicity between the OIT and control groups. However, Black patients comprised 18% of the control group but only 4.1% of the OIT treatment group (p<0.0001). In this study, peanut allergic Black patients were 81% less likely to receive OIT treatment in comparison with peanut allergic White patients. In addition, patients with private insurance comprised a significantly higher proportion of OIT patients. Finally, the Neighborhood Affluence Index, a Census-based measure of the relative socioeconomic prosperity of a neighborhood, was significantly higher in the OIT group vs. the control group, while the Neighborhood Disadvantage Index, a Census-based measure of the relative socioeconomic disadvantage of a neighborhood, was significantly lower. Notably, these trends occurred despite Medicaid-insured patients having no out-of-pocket OIT costs within the university healthcare system. This study uncovered disparities in the racial and socioeconomic profile of patients who utilize OIT versus the broader peanut allergy population. Continued exploration of these findings is crucial to explore the systemic causes of this disparity and facilitate solutions to close this gap and make OIT accessible for all patients.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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