Black children with atopic dermatitis see racial disparities in allergist visits, testing

SAN ANTONIO — Black children with atopic dermatitis appeared less likely than white children to undergo an evaluation by an allergist, according to data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

This finding occurred despite the fact that the atopic march typically begins with atopic dermatitis and can proceed to asthma, which has been shown to occur at higher rates among Black children.

“It was interesting for us to see that, in real-world practice, Black children with asthma and eczema were less likely to see an allergist and less likely to undergo environmental allergy testing than white children with asthma and eczema,” Ellen D. Stephen, MD, a second-year allergy/immunology fellow at Rush University Medical Center, told Healio. “This is important because specialist care and environmental allergy diagnosis can help contribute to better control of asthma and may improve overall asthma outcomes.”

Stephen and colleagues aimed to characterize racial differences within the atopic march among Black children, which they noted has not been as thoroughly researched in contrast to the natural allergy progression among white children.

“We wanted to take a more unique approach of investigating allergic disease disparities among patients who already have all been diagnosed with atopic dermatitis, [which means] physicians know they have a higher risk of developing food allergy, asthma and allergic rhinitis,” Stephen said.

The single-center study consisted of 728 Black children and 246 non-Hispanic white children aged 0 to 18 years with atopic dermatitis.

The researchers conducted a retrospective chart review to determine whether each patient underwent assessment for asthma, using logical regression to analyze the risk for asthma diagnosis in association with several factors, including race, sex, age, BMI, insurance and the Area Deprivation Index (ADI).

Stephen and colleagues found that a significantly greater proportion of Black children had an asthma diagnosis compared with non-Hispanic white children (31.2% vs. 10%; P = .0), with higher BMI, higher ADI and older age at the time of evaluation shown to increase this risk.

Compared with non-Hispanic white children, a significantly smaller proportion of Black children with asthma saw an allergist (46.7% vs. 69%; P = .002) and they were more likely to lack prior inhalant allergy testing (OR = 7.5; P = .03).

“The observed associations by logistic regression do raise important possible factors underlying the observed racial and ethnic disparities in allergist evaluation and objective allergy testing,” Stephen said. “Higher ADI equals more area deprivation equals lower socioeconomic conditions in that patient’s block group, and this may impact factors like insurance status, ability to access specialist care, and ability to afford allergy testing if there is an additional cost. It has been previously reported that there is higher risk of asthma in children from lower socioeconomic status.”

Stephen added that the age at the time of evaluation is equally important because, “for example, we often perform allergy testing in kids when they are a bit older because it takes several years of exposure to develop sensitization.”

The researchers concluded that to reduce disparities in health care, more research is needed to understand underlying factors for racial disparities in atopic dermatitis, as well as on the barriers of diagnosis and management.

Although the study does not carry direct clinical implications, Stephen highlighted the importance of physicians being aware of the aforementioned barriers and, when possible, offer equitable care of asthma diseases to help improve patient outcomes.

“We do think it is important for physicians to refer all pediatric patients with asthma for allergist evaluation when possible, as environmental allergy testing and diagnosis/subsequent management of allergic rhinitis is important to optimizing asthma control,” she said.

Reference:

• Black children with atopic dermatitis less likely to be evaluated by allergists than their white peers. https://www.aaaai.org/About/News/News/2023/atopic-derm. Published Feb. 3, 2023. Accessed Feb. 20, 2023.