Differences in race, ethnicity, and socioeconomic status in schoolchildren dispensed injectable epinephrine in 3 Massachusetts school districts.
BACKGROUND
Published surveys depicting the increase in the incidence of food allergy, especially peanut or tree nut allergy, in children have not reported any differences in race, ethnicity, or socioeconomic status.


OBJECTIVE
To analyze the demographics of schoolchildren with diverse racial, ethnic, and socioeconomic characteristics dispensed injectable epinephrine.


METHODS
School nurses in 44 schools enrolling 21,875 students recorded the characteristics of students dispensed injectable epinephrine in the 2003-2004 school year. Surveyed school districts included 2 affluent suburban districts enrolling 5,855 students (> 92% white) and 1 urban district enrolling 16,020 students (60% nonwhite).


RESULTS
A total of 181 students in all 3 districts were dispensed injectable epinephrine; 118 of these children had peanut or tree nut allergy. Males were more likely to be dispensed injectable epinephrine than females (odds ratio [OR], 1.44; P < .02). Whites were more likely to have been dispensed injectable epinephrine than nonwhites (OR, 4.76; P < .001). Whites were nearly 5 times more likely to be dispensed injectable epinephrine for peanut or tree nut allergy than nonwhites (OR, 4.5; P < .001). Most students (75%) dispensed injectable epinephrine for peanut or tree nut allergy were enrolled in prekindergarten through grade 5 (P < .001). Whites were more likely than nonwhites to be dispensed injectable epinephrine for stinging insect allergy (OR, 8.7; P < .001).


CONCLUSIONS
This study found significant racial, ethnic, and socioeconomic differences in the prevalence of childhood allergic disorders, especially peanut or tree nut allergy, requiring prescribed injectable epinephrine in a school setting. Additional studies are needed to determine whether minority children are being underdiagnosed or undertreated for allergic disorders requiring injectable epinephrine or whether they truly have a lower incidence of such allergic disorders.
Hannaway
Paul J
PJ
Division of Allergy and Immunology, North Shore Medical Center, Salem, Massachusetts, USA. lhtpress@aol.com
Connelly
Mary Ellen
ME
Cobbett
Roberta M
RM
Dobrow
Paula J
PJ
D000293:Adolescent; D044466:Asian People; D044383:Black People; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004837:Epinephrine / Q000627:therapeutic use*; D005260:Female; D005512:Food Hypersensitivity / Q000188:drug therapy* / Q000453:epidemiology*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D021184:Nut Hypersensitivity / Q000188:drug therapy / Q000453:epidemiology; D012923:Social Class; D013383:Suburban Population; D014505:Urban Population; D044465:White People; D001741:Black or African American
D001993:Bronchodilator Agents; D004837:Epinephrine