December 21, 2022

3 min read


Klein S, et al. Poster P192. Presented at: ACAAI Annual Scientific Meeting; Nov. 10-14, 2022; Louisville, Ky.

The authors report no relevant financial disclosures.

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LOUISVILLE, Ky. — There is an education gap pertaining to anaphylaxis among Black individuals with food allergy, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.

A lack of awareness about anaphylactic symptoms and how to treat them can lead to disproportionately worse outcomes for Black individuals with food allergy, Sara Klein, MBA, director of market research for Food Allergy Research and Education, said during her presentation.

Man uses epinephrine autoinjector
Although similar rates of white and Black respondents with food allergy and a history of anaphylaxis reported that they carry epinephrine, only 21.8% of white respondents and 8.1% of Black respondents knew it should be the first thing to use when an anaphylactic reaction develops. Source: Adobe Stock

Sara Klein

“Food allergies are a potentially life-threatening health condition affecting 32 million Americans,” Klein said. “Racial and economic disparities related to this condition have already been established.”

Black Americans are more likely than white Americans to have food allergy, with higher risks for adverse outcomes such as ED visits and anaphylaxis due to food allergy for Black children as well, the researchers said.

In May 2022, the researchers conducted an online survey of 1,006 adults (61.2% women) who had reported a multi-system reaction to one of the top nine most common allergens suggestive of anaphylaxis

Age ranges included 18 to 34 years (41.3%), 35 to 49 years (30.2%), 50 to 64 years (18.8%) and 65 years or older (9.7%). Demographics included white (60.5%), Black (16.3%) and Hispanic (15.4%).

Also, 55.3% of the respondents reported a lifetime history of food-induced anaphylaxis, including 54.2% of white respondents and 52.4% of Black respondents, which the researchers said represented no significant difference.

Those with a history of anaphylaxis included 45.7% who reported an anaphylactic reaction to a food that they had eaten safely in the past, which the researchers considered a proxy for a new food allergy, with no significant differences between white (46.4%) and Black (44.2%) respondents.

“We see a big difference, however, in the percent reporting an anaphylactic reaction to a food which had been eaten in the past with self-reported mild symptoms, something that is not recommended because the severity of food allergic reactions is unpredictable,” Klein said.

Overall, 32.2% of respondents had an anaphylactic reaction to a food that had only caused mild symptoms previously, including 25.8% of white and 39.5% of Black respondents, which the researchers called a significant difference (P < .05).

“We also see troubling differences in awareness of anaphylactic symptoms,” Klein said.

Only 56.7% of Black respondents recognized trouble breathing as a sign of an anaphylactic emergency, compared with 74.2% of white respondents.

Black respondents similarly lagged white respondents in recognizing tightness in the throat, shortness of breath, trouble swallowing, loss of consciousness and weak pulse as anaphylactic symptoms.

Epinephrine carriage was similar among respondents, as 26.7% reported that they have an unexpired EpiPen (Viatris/Mylan Inc.), including 27.1% of white and 25.6% of Black respondents.

But when asked what they should do when someone begins to show symptoms of anaphylaxis, 42.7% of Black and 52.4% of white respondents (P < .05) knew that they should immediately use an epinephrine autoinjector such as their EpiPen, which Klein called the only treatment that will stop anaphylaxis.

Of respondents who experienced an anaphylactic reaction, 19.2% overall reported administering epinephrine as their first action, with a substantial difference between Black (8.1%) and white respondents (21.5%), even though they carry epinephrine at similar rates, the researchers said.

In considering first actions after showing symptoms of anaphylaxis, there was an insignificant difference in antihistamine use between Black and white respondents (20.9% vs. 23.9%), whereas a greater proportion of Black respondents also reported first waiting to see if symptoms improved or doing “something else.”

Further, a smaller proportion of Black respondents discussed anaphylaxis risks with their doctors, regardless of whether they saw an allergist or a primary care provider for their food allergy in the previous year (P < .05). A smaller proportion of Black individuals also reported receiving a referral from their primary care provider (P < .05).

In addition to the differences in awareness about anaphylactic symptoms, these differences in discussions with clinicians may be why Black and white respondents make different choices during anaphylaxis episodes, the researchers said.

“We believe a lack of awareness about the symptoms of anaphylaxis exacerbated by a lack of knowledge about how to treat an anaphylactic reaction can only lead to disproportionately worse outcomes for African Americans,” Klein said. “Efforts are needed to close the gap in anaphylaxis education.”

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