Abstract
Introduction
Food allergy affects approximately 8% of U.S. children. While allergen avoidance remains the standard of care, it can significantly impact quality of life. Oral immunotherapy (OIT) is an established treatment option that induces desensitization through gradual allergen exposure. Prior studies have reported racial and socioeconomic disparities in OIT utilization. This study aimed to characterize pediatric patients receiving OIT in Hampton Roads and identify potential disparities in access to care.
Methods
We conducted a retrospective cohort study of pediatric patients who underwent OIT at Children's Hospital of The King's Daughters (CHKD) Allergy & Immunology clinics between January 1, 2020, and February 10, 2026. Patients were identified through a secure database. Demographic, clinical, treatment, and socioeconomic data were collected, including race/ethnicity, atopic comorbidities, insurance status, home value, OIT food, use of Palforzia or omalizumab, and adverse reactions. Home values were compared with the June 2026 Hampton Roads median sale price ($395,000).
Results
Ninety-two patients underwent OIT. Most identified as White (82.6%), non-Hispanic (97.8%), and male (54.3%). Atopic dermatitis (72.8%), allergic rhinitis (44.6%), and asthma (23.9%) were common comorbidities. Peanut OIT was the most frequently prescribed therapy (67.4%), followed by milk (13.0%) and Palforzia (12.0%).
A total of 108 OIT-related reactions occurred; 52 patients (56.5%) experienced at least one reaction with 15 reactions occurring in clinic on up-dosing. Twenty-four reactions (22.2%) required epinephrine, and 5 patients required emergency department evaluation, all following home dosing. Eight patients received omalizumab prior to OIT initiation, and none experienced OIT-related reactions.
Potential socioeconomic disparities were identified. Mean home value among OIT patients was $644,072, substantially above the regional median sale price, with 83.0% of patients residing in homes valued above regional median. Most patients had private insurance (73.9%) or Tricare (22.8%), while only 5.4% had Medicaid coverage.
Conclusion
Pediatric OIT patients in Hampton Roads were predominantly White, non-Hispanic, and from relatively affluent backgrounds. OIT was generally safe, with few severe reactions and no reactions among patients receiving omalizumab prior to treatment. These findings suggest potential racial and socioeconomic disparities in OIT utilization and highlight the need to improve access to food allergy therapies for underserved populations.