Oppressed racial, ethnic communities experience greater burdens of allergic disease

Key takeaways:

• Black patients had noticeable increases in hospitalization and mortality due to asthma compared with white patients, especially among children.
• Increased burdens of asthmatic disease among First Nations and Inuit communities were attributed to smoking, housing and air quality.
• African American and Hispanic children had higher odds for allergies to foods that include wheat, soy, corn and fish than white children.

Members of racial and ethnic communities that have been oppressed structurally may face increased burdens of allergic and atopic disease, according to a review published in The Journal of Allergy and Clinical Immunology: In Practice.

Also, issues pertaining to oppression, access and the social environment may magnify these burdens, Syeda Jafri, BSc, of the Max Rady College of Medicine, University of Manitoba, and colleagues wrote in the study.

The scoping literature review comprised five studies on Black or African American populations, three on Indigenous Peoples of Canada and four on combinations of these groups and Hispanic or “Latinx” populations, the researchers said. None of the studies exclusively examined Hispanic, “Latinx” or Native American populations or identity.

Findings for Black and African American populations

The five studies on Black or African American populations included a retrospective chart review and four cohort studies. Also, four of these studies exclusively covered pediatric patients, and one was about adults.

These studies all were from the U.S. and published between 2006 and 2021. Two exclusively were about asthma, and three examined eosinophilic esophagitis (EoE), food allergy and allergic contact dermatitis.

One of the asthma studies found noticeable increases in hospitalization and mortality for Black patients compared with white patients, particularly among children. The other asthma study found that Black adolescents with asthma were 3.1 times more likely to have overweight or obesity than those without asthma (P = .02).

In a study about the clinical presentation of EoE, African American children had a larger disease burden and differences in clinical presentation that white children did not commonly report, even though equal proportions of African American and white children were affected by the disease. The authors of that study attributed these differences to greater frequency of endoscopy tests among white patients.

The study on food allergy found that African American children had different food allergen profiles than white children, including with the top nine allergens. Also, African American children with food allergy had higher prevalence of comorbid asthma than white children.

When allergic contact dermatitis was studied, African American individuals more commonly experienced lichenification and hyperpigmentation than white patients. The study authors also found that low clinical suspicion often may lead to missed dermatitis, with delays in referrals for patch testing.

Findings for Indigenous populations

The three cross-sectional studies of asthma, food allergy and/or atopy in Indigenous Peoples of Canada were published in the 2010s.

After a telephone survey of First Nations and Inuit communities, the authors of one study attributed the increased burden of asthmatic disease to smoking, housing, air quality and other environmental factors as well as lack of access to adequate expertise and knowledgeable health care professionals.

A second study found that 15.9% of children aged 5 and 6 years of Iqaluit identity had current asthma, with twice as many boys affected as girls. Also, 6.8% had current or past allergic rhinitis, predominantly among boys, and 20.5% had eczema.

In the third study of Indigenous Peoples of Canada, the general population and Indigenous peoples had comparable prevalences of perceived and probable food allergy.

Findings for mixed populations

Among the studies investigating mixed populations, one investigation found African American females more frequently visiting ED and/or being admitted for inpatient treatment and monitoring due to acute asthma exacerbations. Plus, African American patients required higher inhaled corticosteroid doses each day than white patients, increasing their overall costs for asthma.

A second study of African American and Hispanic populations found a direct and significant association between allergen sensitization and asthma severity (P < .001) with no difference in degree of sensitization between these populations.

In a third study, African American and Hispanic children had greater odds of allergies to foods that included wheat, soy, corn and fish than white children. Also, the odds for having asthma (58.6%; OR = 2.34; 95% CI, 1.63-3.4) and eczema (56.5%; OR = 1.2; 95% CI, 1.28-2.35) were significantly higher for African American children than non-Hispanic white children.

Similarly, Hispanic children had higher odds for asthma (56.1%; OR = 1.86; 95% CI, 1.17-2.95) than non-Hispanic white children, but comparable rates of asthma. Higher rates of anaphylaxis were found among African American (OR = 2.36; 95% CI, 1.39-3.52) and Hispanic children (OR = 2.8; 95% CI, 1.7-4.64) than white children as well.

Conclusions and next steps

Noting these increased burdens among structurally oppressed racial and ethnic communities, the authors of the review said that the current literature has yet to address how issues surrounding oppression, access and social environment magnify these challenges.

Also, the authors said that the current literature almost certainly underestimates the burden of allergic disease among these populations. Yet future investigations, the authors cautioned, should involve community partnerships that ensure the right questions are being asked to yield a more complete understanding of the relevant issues.