Black children with eczema less likely to undergo testing to confirm food allergy

Key takeaways:

• More Black children with eczema and food allergy had no testing done to confirm the food allergy diagnosis compared with white children.
• Black children were less likely to undergo both skin and blood testing.

ANAHEIM, Calif. — Non-Hispanic Black children with eczema appeared significantly less likely to undergo skin and blood testing to confirm a food allergy compared with white children, according to results of a retrospective cohort study.

During her presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting, Manali Shah, MD, an internal medicine resident at Rush University Medical Center, cited CDC data showing that 10.8% of children had eczema and 5.8% had food allergy in 2021. Also, rates of food allergy were higher in non-Hispanic Black children (7.6%) compared with white children (5.3%), but the data did not indicate what food allergy testing was done.

“I wanted to evaluate racial disparities in food allergy because as I rotated through the clinic at my institution, I noticed there seemed to be barriers in obtaining food allergy testing,” Shah told Healio. “I wanted to further investigate if these barriers were related to racial groups.”

Shah and colleagues conducted a single-center study looking at 3,365 children aged 0 to 18 years with a diagnosis of both atopic dermatitis and food allergy, many of whom were from historically underrepresented groups (41.3% non-Hispanic Black; 33.9% Hispanic; 14.9% non-Hispanic white; 6.9% Asian). Researchers conducted a chart review to determine the food allergy diagnosis, specific food allergy group and what tests were done to confirm the diagnosis.

Overall, 61.4% of the children had Medicaid — including 76.3% of the Black children, 62.8% of the Hispanic children, 37.5% of the Asian children and 29.1% of the white children — 38.5% had private insurance and insurance status was unknown for the remaining 0.1%.

Also, researchers further assessed socioeconomic status using the Area Deprivation Index, finding that the Black and Hispanic children appeared to be more socioeconomically disadvantaged than the white and Asian children.

Results showed a significantly greater proportion of non-Hispanic Black children had no objective testing to support a food allergy diagnosis compared with white children (20.9% vs. 12.5%; P < .05).

Reasons for this disparity could be insurance issues, cultural reasons or transportation barriers to undergo additional testing, Shah said.

Significantly fewer Black children had both skin and blood testing compared with white children as well (7.1% vs. 15.5%; P < .01).

However, when evaluating blood testing and skin testing separately, researchers did not observe significant differences across the four studied groups.

“A theory I had for [this finding] is that maybe these groups are more closely followed by allergists compared with people who didn’t have the testing,” Shah said during her presentation, adding that many primary care groups at Rush were doing blood panel testing for food allergies, even though that test alone didn’t reveal significant differences.

Shah acknowledged that the retrospective analysis was limited by the use of the electronic medical record, but she told Healio their results likely are reflective of not only their institution.

“I do think these results would be replicable in larger populations as our study represented a large, urban population with historically underrepresented groups,” she said.

“The implications of less food allergy testing among non-Hispanic Black children is that these children may be avoiding foods that they might not need to which can alter their nutritional status and impact their lifestyle,” she added.

Next, Shah and colleagues plan to conduct a prospective study to screen patients in the allergy clinic to determine underlying barriers to food allergy testing.