Background. Food allergy (FA) is associated with poor quality of life and high levels of psychological distress. Psychological support is therefore extremely important but is not always available. As part of the Global Access to Psychological Services for Food Allergy (GAPS) Study, we aimed to assess distress and use of psychological services for adults with food allergy. Methods. Participants (n=1329 adults with FA) from >20 countries were recruited through patient organisations, social media adverts and online survey panels to complete an online survey. Surveys were offered in six languages. Results. A total of 67.7% of adults reported they had experienced FA-related psychological distress with the biggest issue being anxiety about having an allergic reaction (64.1%). Only 19.4% had been assessed for FA-related psychological distress; 22.9% had seen a mental health professional for treatment for their FA-related distress. There were significant differences across countries for levels of distress, screening for distress, seeing a mental health professional and being diagnosed with a FA-related mental health disorder (all p<0.001). The UK and Brazil had the highest number of adults reporting distress. The biggest barriers to seeing a mental health professional were cost, lack of insurance coverage, failure to provide a referral, and lack of practitioner in the area. Conclusions. FA-related distress is common in adults. Few have accessed the psychological care and support they need and there is significant variability across countries. Clinicians should consider routine assessment of adults for distress and easily accessible resources are needed to help support adult patients.

A large and growing corpus of epidemiologic studies suggests that the population-level burden of pediatric FA is not equitably distributed across major sociodemographic groups, including race, ethnicity, household income, parental educational attainment, sex). As is the case for more extensively studied allergic disease states such as asthma and atopic dermatitis) epidemiologic data suggest that FA may be more prevalent among certain populations experiencing lower socioeconomic status (SES), particularly those with specific racial and ethnic minority backgrounds living in highly urbanized regions. Emerging data also indicate that these patients may also experience more severe FA-related physical health, psychosocial and economic outcomes relating to chronic disease management. However, many studies that have identified sociodemographic inequities in FA burden are limited by cross-sectional designs that are subject to numerous biases, which can reduce the epidemiologic utility of the resulting estimates. Compared to cross-sectional study designs or cohorts that are recruited during childhood, birth cohorts can offer advantages relative to other study designs when investigators seek to understand causal relationships between exposures occurring during the prenatal or postnatal period and the atopic disease status of individuals later in life. Numerous birth cohorts have been established across recent decades, which include evaluation of food allergy-related outcomes, and a subset of these also have measured sociodemographic variables that, together, have the potential to shed light on the existence and possible etiology of sociodemographic inequities in food allergy. This manuscript attempts to survey the current state of this birth cohort literature and draw insights regarding what is currently known, and what further information can potentially be gleaned from thoughtful examination and further follow-up of ongoing birth cohorts across the globe.

Background: The effect of race, age, sex, atopy, environmental exposures, and social determinants of health on total serum immunoglobulin E (IgE) has not been examined in children with food allergy. Method: We conducted a cross-sectional analysis with univariable and multivariable linear mixed effect models of data from 398 African American and European American children 0-12 years with allergist-diagnosed food allergy from the multi-center, observational cohort FORWARD; total serum IgE in kU/L was the primary outcome measure. Results: Total serum IgE positively associated with African American race ( p < .0001), older age ( p < .0001), male sex ( p =. 0142), lower household income ( p = .0051), lower parent/caregiver education ( p = .0051), allergic rhinitis ( p < .0001), asthma ( p < .0001), eczema ( p = .0240), and a higher number of food allergies ( p < .0001), but not tobacco smoke exposure. After covariate adjustment in multivariable analysis, total serum IgE remained higher in African American than European American ( p < .0001), older than younger ( p < .0001), and male than female children and in children with allergic rhinitis ( p = .0083), asthma ( p < .0001), eczema ( p = .0140), and a higher number of food allergies ( p < .0001). Conclusions: We provide foundational data that total serum IgE varies by race in children with food allergy; values were higher in African American than European American children, independent of atopic status. These findings call attention to the need to establish race-dependent values of total serum IgE for diagnostic and therapeutic purposes.

Racial Differences in Timing of Food Allergen IntroductionAudrey Brewer, MD MPH 1; Jialing Jiang, BA2; Christopher M. Warren, PhD 2; Hemant P. Sharma, MD, MHS 3; Mary C. Tobin, MD4; Amal Assa’ad, MD 5; Ruchi S. Gupta, MD MPH 1,2* on behalf of the FORWARD Team1. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois, United States2. Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States3. Children’s National Hospital, Washington, District of Columbia, United States4. Rush University Medical Center, Chicago, Illinois, United States5. Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, United States