Sociodemographic factors linked to food allergy diagnosis among high-risk children with atopic dermatitis

Ellen Daily Stephen; Sven Wang; Manali Shah; Anandu Dileep; Shannon Manz; Niki Mirhosseini; Mahboobeh Mahdavinia

doi:10.1016/j.anai.2024.04.016

Sociodemographic factors linked to food allergy diagnosis among high-risk children with atopic dermatitis

Ann Allergy Asthma Immunol. 2024 Apr 20:S1081-1206(24)00236-9. doi: 10.1016/j.anai.2024.04.016. Online ahead of print.

Authors

Ellen Daily Stephen¹, Sven Wang², Manali Shah², Anandu Dileep², Shannon Manz², Niki Mirhosseini³, Mahboobeh Mahdavinia⁴

Affiliations

¹ Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois. Electronic address: ellendailystephen@gmail.com.
² Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
³ Department of Internal Medicine, Indiana University Bloomington, Bloomington, Indiana.
⁴ Division of Allergy/Immunology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.

PMID: 38648973
DOI: 10.1016/j.anai.2024.04.016

Abstract

Background: Atopic dermatitis (AD) is a known risk factor for the development of food allergy (FA). Prior work has suggested disparities in diagnosis/management of FA in urban populations.

Objective: To determine whether socioeconomic conditions, as measured by the area deprivation index and insurance status, or racial/ethnic self-identity was associated with risk of FA diagnosis (DFA), evaluation by an allergist, or objective FA testing among high-risk children with AD.

Methods: This is a retrospective cohort study of pediatric patients with physician-diagnosed AD who had received primary care at a single urban academic tertiary care center between 2009 and 2022. Statistical analysis in SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY) used χ², analysis of variance, and logistic regression.

Results: In a total of 3365 pediatric subjects, 41.3% identified as non-Hispanic Black, 33.9% Hispanic, 6.9% Asian, and 14.9% non-Hispanic White. Hispanic children with AD and DFA were significantly less likely to be evaluated by an allergist than White or Asian children (65.9% vs 82.8% and 80.3%, P = .001 and P = .02). Non-Hispanic Black children with AD and DFA were more likely to have no objective FA testing than White children (20.9% vs 12.1%, P = .04). The White and Asian children were more likely to undergo the thorough combination of both blood and skin testing for DFA than Black or Hispanic children (15.5% and 22.4% vs 7.1% and 7.9%, respectively, P = .007, P = .00005, P = .03, P = .0008).

Conclusion: Labeling at-risk young children with FA without thorough objective testing can affect their nutrition and quality of life. Barriers to equitable evaluation of DFA should be further investigated and addressed.