PROJECT SUMMARY/ABSTRACT Background: Food allergy (FA) is a potentially life-threatening condition that affects an estimated 8% of children in the United States. Although differences between Black, White, and Latinx children in the prevalence and severity of other atopic conditions such as asthma and eczema have been well described, little is known about such differences in FA. Black children may have worse clinical outcomes, including rates of FA-related fatal anaphylaxis and FA-related emergency department(ED) visits, than their White peers. Phenotypic and endotypic differences, including rates of sensitization and co-morbidities, between Black and White children are beginning to be examined. Data on racial differences in FA management practices are incomplete; preliminary data suggest that Black families spend significantly less on allergen- free foods and FA medications than do White families. Families caring for children with FA experience significant impairments in psychosocial outcomes, including FA-related quality of life (FAQoL); however, these data come primarily from White, privately insured families, and little is known about psychosocial outcomes in Black families. There is limited data on these outcomes among the Latinx population of children food allergy. Two recent reviews concluded that existing studies examining racial disparities in FA are far too methodologically limited to draw definitive conclusions, primarily due to reliance on self-report of FA diagnosis and cross-sectional designs. Specific Aims and Methods: Our goal is to prospectively study a cohort of 1,450 Black, White, and Latinx children with FA in order to: 1) Determine the clinical and sociodemographic factors associated with differences in the development of clinical immune tolerance and the development of new food allergies; 2) Determine differences in FA management and outcomes during pivotal developmental periods (i.e. middle childhood; adolescence) by expanding assessment of patient-reported outcomes to include dyadic assessment of the following caregiver-reported and patient self-reported constructs: Psychosocial Outcomes and Disease Management (e.g. epinephrine carriage and allergen exposure) and Eating behaviors and nutrition environments (e.g. in the home and community). 3) Identify phenotypic and endotypic differences in FA by applying state-of-the-art precision medicine approaches for multidimensional phenotyping and endotyping of FA patients. Hypotheses and Expected Results: We hypothesize that compared to White children, Black children are less likely to develop clinical immune tolerance to foods and more likely to develop new-onset food allergy during the study period. We also hypothesize that concordance between patient- and caregiver-report data will decrease as children age and eating behaviors and nutrition environment will differ by child race/ethnicity. Additionally, we hypothesize that White, Black, Mexican-American and Puerto-Rican c...