Visiting an allergist reduced ED visits, hospitalizations among children with asthma

Key takeaways:

• Most children who saw an allergist had persistent asthma and were atopic.
• Seeing an allergist reduced the odds of going to the ED or being hospitalized by 21%.

Children with asthma who visited an allergy specialist were 21% less likely to visit the ED or be hospitalized compared with children who did not, according to findings published in The Journal of Pediatrics.

“Studies in adults have shown that even one asthma specialist visit improves outcomes for patients, including reductions in ED visits and prescriptions for asthma reliever inhalers,” Melanie Boyd, MS, a PhD candidate at the University of Arkansas for Medical Sciences, and colleagues wrote. “The goal of this study was to evaluate the comparative effectiveness of allergy specialist care, compared to no allergy specialist care, for children with asthma enrolled in the Arkansas Medicaid program.”

Their study included 21,896 children (58% boys) aged 5 to 18 years who were enrolled in Medicaid in 2018 and 2019 and had been diagnosed with asthma. According to the researchers, nearly half of children in Arkansas are enrolled in Medicaid. They matched 2,964 children who visited an allergy specialist at least once in 2018 with 2,964 children who did not to compare the rates of asthma-related ED visits or hospitalizations in 2019.

Overall, 3,031 children had at least one visit with an allergist, whereas 18,865 children did not. More than half of those who visited an allergist (54.2%) had persistent asthma, compared with 25% of those without an allergist visit. Almost all children (94.8%) who saw an allergist were atopic vs. 63.8% who did not.

Out of all children in the unmatched sample, 8.9% had at least one asthma-related ED visit or hospitalization, Boyd and colleagues reported. In the matched sample, the proportion was 10.1%.

After adjusting the data, Boyd and colleagues found that children who visited an allergist were 21% less likely to visit the ED or be hospitalized than those who did not (adjusted OR = 0.79; 95% CI, 0.63-0.98).

A significantly larger proportion of Black children visited the ED compared with white children whether they saw an allergist or not (10.3% vs. 5.9% and 10.5% vs. 6.4%, respectively; P < .01 for both).

Children with persistent asthma were more likely to visit the ED with or without an allergist visit (10.2% vs. 4.2% and 11.3% vs. 5.1%, respectively; P < .001 for both). Even with an allergist, they were more likely to be hospitalized than children without persistent asthma (3.6% vs. 1.9%; P < .01).

“Population health management programs need to consider allergy specialist care as a quality metric following guideline-based recommendations,” the authors wrote. “The evidence presented here suggests that provider-level interventions to increase the appropriate utilization of allergy specialty care have the potential to improve child health outcomes, especially in Medicaid-enrolled children.”