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Dupuis R, Phipatanakul W, Bartnikas LM. Social disparities in early childhood prevention and management of food allergy. J Allergy Clin Immunol 2023; 151:37-41. [PMID: 36608981 PMCID: PMC9830563 DOI: 10.1016/j.jaci.2022.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/09/2022] [Accepted: 10/14/2022] [Indexed: 01/05/2023]
Abstract
Food allergy (FA) affects 8% of US children. Navigating and managing FA permeates across multiple facets of childhood. In this article, we review research on social disparities in feeding practices, managing meals, and selecting childcare and schools. Key highlights include the following: (1) although preference for breast-feeding or formula feeding does not reduce FA risk, there are disparities in access to formula that may affect children with FA; (2) disparities likely exist in the early introduction to allergenic foods, though additional research is needed to identify barriers to following the most recent consensus guidelines on early introduction; (3) families with limited income face challenges in providing safe meals for their children; (4) disparities exist in early childcare options for preschool-age children, though there is a lack of research on FA practices in these settings; and (5) there is evidence that schools with different student demographics implement different types of FA policies. Further research is needed to better understand and characterize social disparities in FA prevention and management in early childhood and to develop evidence-based strategies to reduce them.
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Affiliation(s)
- Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, Mass; Harvard Medical School, Boston, Mass.
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LeBovidge JS, Herbert LJ, Ramos A, Rotter N, Sicherer SH, Young MC, Pistiner M, Phipatanakul W, Bartnikas LM, Bingemann TA. The Development of Age-Based Food Allergy Educational Handouts for Caregivers and Patients: A Work Group Report of the AAAAI Adverse Reactions to Foods Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2552-2558. [PMID: 36030195 PMCID: PMC9555009 DOI: 10.1016/j.jaip.2022.01.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 01/20/2022] [Accepted: 01/21/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Food allergy education is an ongoing process that must address unique safety concerns and psychosocial challenges at each developmental stage. Families require reliable information that is targeted to specific developmental stages to support the integration of food allergy management into daily life. OBJECTIVE The purpose of this project was to develop age-specific, evidence-based patient education handouts with practical recommendations for managing and coping with food allergies at different developmental stages. METHODS Handout content was based on: (1) practice guidelines for food allergy management; (2) literature addressing psychosocial and educational needs of patients with food allergy and their caregivers; and (3) clinical experience of the project team. Fifty-seven caregivers of patients (aged 0-21 years) with food allergy and 2 young adults with food allergy reviewed a draft of the handouts and completed an online survey to assess handout acceptability and usability and identify areas for improvement. Handouts were revised based on participant feedback. RESULTS The majority of participants (79%) rated the amount of information in the age-specific handouts as "just right," versus "not enough" (9%) or "too much" information (12%). Sixty-three percent reported that they would be "very likely" to use the handouts as a resource and 35% "somewhat likely." Almost all participants (88%-100% by item) agreed that the handouts used elements of plain language writing and clear communication. CONCLUSION Caregivers rated the age-based food allergy education handouts as understandable and useful. We anticipate that these handouts could be used during health care visits and directly accessed online by families.
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Affiliation(s)
- Jennifer S LeBovidge
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Psychiatry, Harvard Medical School, Boston, Mass.
| | - Linda J Herbert
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Ashley Ramos
- Division of Allergy and Immunology, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine, Washington, DC
| | - Nancy Rotter
- Department of Psychiatry, Harvard Medical School, Boston, Mass; Department of Pediatrics, Food Allergy Center, Massachusetts General Hospital for Children, Boston, Mass
| | - Scott H Sicherer
- Division of Allergy and Immunology, Elliot and Roslyn Jaffe Food Allergy Institute, Kravis Children's Hospital, New York, NY; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael C Young
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Michael Pistiner
- Department of Pediatrics, Food Allergy Center, Massachusetts General Hospital for Children, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Wanda Phipatanakul
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Lisa M Bartnikas
- Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - Theresa A Bingemann
- Division of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester Medical Center, Rochester, NY; Division of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine and Dentistry, Rochester, NY
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Okelo SO. Structural Inequities in Medicine that Contribute to Racial Inequities in Asthma Care. Semin Respir Crit Care Med 2022; 43:752-762. [DOI: 10.1055/s-0042-1756491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractStructural inequities in medicine have been present for centuries in the United States, but only recently are these being recognized as contributors to racial inequities in asthma care and asthma outcomes. This chapter provides a systematic review of structural factors such as racial bias in spirometry algorithms, the history of systemic racism in medicine, workforce/pipeline limitations to the presence of underrepresented minority health care providers, bias in research funding awards, and strategies to solve these problems.
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Affiliation(s)
- Sande O. Okelo
- Division of Pediatric Pulmonology and Sleep Medicine, The David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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54
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Justvig SP, Haynes L, Karpowicz K, Unsworth F, Petrosino S, Peltz A, Jones BL, Hickingbotham M, Cox J, Wu AC, Holder-Niles FF. The Role of Social Determinants of Health in the Use of Telemedicine for Asthma in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2543-2549. [PMID: 35863670 DOI: 10.1016/j.jaip.2022.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 06/22/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
Asthma is the most common chronic health condition among children in the United States. The adverse impacts of social determinants of health often manifest in unmet health-related social needs, potentially contributing to worse asthma outcomes. With the onset and rapid spread of coronavirus disease 2019 (COVID-19) and the identification of asthma as a potential risk factor for more severe disease, our asthma program quickly pivoted to a remote-access telemedicine asthma population management platform to best meet the needs of our most at-risk patients. Our practice provides care to a large proportion of Black and Latino/a/e children in urban areas insured by the State Medicaid Program and impacted by unmet social needs. As we pivoted to telemedicine, we consistently reached a greater number of patients and families than prepandemic and observed decreased emergency department visits and hospitalizations. About 1 in 5 families received resource touch points spanning categories of transportation, food and supplies, clothing, utilities, and rent. Overall, families reported positive experiences with telemedicine, including the ability to connect remotely with our social work and resource teams. Telemedicine may be an effective strategy for addressing both the medical and the social needs of children with asthma at risk for worse outcomes.
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Affiliation(s)
- Sarah P Justvig
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Linda Haynes
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Kristin Karpowicz
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Fiona Unsworth
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Sheila Petrosino
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Alon Peltz
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Bridgette L Jones
- Children's Mercy Hospital, University of Missouri-Kansas City School of Medicine, Kansas City, Mo
| | - Madison Hickingbotham
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
| | - Joanne Cox
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass
| | - Ann Chen Wu
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass.
| | - Faye F Holder-Niles
- Division of General Pediatrics, Boston Children's Hospital Harvard Medical School, Boston, Mass.
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Olivieri B, Stoenchev KV, Skypala IJ. Anaphylaxis across Europe: are pollen food syndrome and lipid transfer protein allergy so far apart? Curr Opin Allergy Clin Immunol 2022; 22:291-297. [PMID: 35942860 DOI: 10.1097/aci.0000000000000847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Traditionally pollen-food syndrome (PFS) is considered to be a mild cross-reacting food allergy affecting only Northern Europe, with lipid transfer protein (LTP) allergy being more severe and mainly occurring in Southern Europe. This review seeks to update the reader on both types of plant food allergy and to determine whether the stereotypical presentations of these plant food allergies remain the same, with a particular focus on reaction severity. RECENT FINDINGS Recent findings suggest that both these types of plant food allergy occur in children and adults. Although it is true that PFS allergy is more prevalent in Northern Europe and LTP allergy is more well known in Southern Europe, these conditions are not hidebound by geography, and the increasing spread and allergenicity of pollen due to global warming continues to change their presentation. Both conditions have a spectrum of symptom severity, with PFS sometimes presenting with more severe symptoms, including anaphylaxis and LTP allergy with milder reactions. SUMMARY It is important to consider that in many parts of Europe, reactions to plant foods, especially fruits or vegetables, could be mediated either by pollen cross-reactivity or primary sensitization to LTP allergens. All those presenting with symptoms to plant foods will benefit from a detailed clinical history and appropriate tests so that an accurate diagnosis can be made, and correct management implemented.
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Affiliation(s)
- Bianca Olivieri
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - Kostadin V Stoenchev
- Royal Brompton & Harefield Hospitals, Part of Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Isabel J Skypala
- Royal Brompton & Harefield Hospitals, Part of Guys and St Thomas NHS Foundation Trust, London, United Kingdom
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Leeds S, Nowak-Wegrzyn A. Defining socioeconomic and racial disparities in food allergy: The time is now. Ann Allergy Asthma Immunol 2022; 129:391-392. [PMID: 36155692 DOI: 10.1016/j.anai.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/14/2022]
Affiliation(s)
| | - Anna Nowak-Wegrzyn
- Department of Pediatrics, Hassenfeld Children's Hospital, NYU R. Grossman School of Medicine, New York, New York; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Polan.
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Park H, Pappalardo AA. Invited Perspective: Call to Action-Reduce Immigrants' Disparities in Environmental Exposures and Health. ENVIRONMENTAL HEALTH PERSPECTIVES 2022; 130:91301. [PMID: 36053725 PMCID: PMC9438917 DOI: 10.1289/ehp11003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 07/25/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Henna Park
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrea A. Pappalardo
- Department of Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Internal Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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58
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O'Donoghue J, Luther J, Hoque S, Mizrahi R, Spano M, Frisard C, Garg A, Crawford S, Byatt N, Lemon SC, Rosal M, Pbert L, Trivedi M. Strategies to improve the recruitment and retention of underserved children and families in clinical trials: A case example of a school-supervised asthma therapy pilot. Contemp Clin Trials 2022; 120:106884. [PMID: 35995130 PMCID: PMC9489677 DOI: 10.1016/j.cct.2022.106884] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/24/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Due to underrepresentation of racial/ethnic minority and low-income groups in clinical studies, there is a call to improve the recruitment and retention of these populations in research. Pilot studies can test recruitment and retention practices for better inclusion of medically underserved children and families in subsequent clinical trials. We examined this using a school-based asthma intervention, in preparation for a larger clinical trial in which our goal is to include an underserved study population. METHODS We recruited children with poorly controlled asthma in a two-site pilot cluster randomized controlled trial of school-supervised asthma therapy versus enhanced usual care (receipt of an educational asthma workbook). We sought a study population with a high percentage of children and families from racial/ethnic minority and low-income groups. The primary outcome of the pilot trial was recruitment/retention over 12 months. Strategies used to facilitate recruitment/retention of this study population included engaging pre-trial multi-level stakeholders, selecting trial sites with high percentages of underserved children and families, training diverse medical providers to recruit participants, conducting remote trial assessments, and providing multi-lingual study materials. RESULTS Twenty-six children [42.3% female, 11.5% Black, 30.8% Multiracial (Black & other), 76.9% Hispanic, and 92.3% with family income below $40,000] and their caregivers were enrolled in the study, which represents 55.3% of those initially referred by their provider, with 96.2%, 92.3%, and 96.2% retention at 3-, 6-, and 12-month follow-up, respectively. CONCLUSION Targeted strategies facilitated the inclusion of a medically underserved population of children and families in our pilot study, prior to expanding to a larger trial.
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Affiliation(s)
- Julia O'Donoghue
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America.
| | - Janki Luther
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States of America
| | - Shushmita Hoque
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Raphael Mizrahi
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Michelle Spano
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Christine Frisard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Sybil Crawford
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Nancy Byatt
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Milagros Rosal
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
| | - Michelle Trivedi
- Division of Pulmonology, Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, MA, United States of America; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, United States of America
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Scurlock AM, Brown E, Davis CM. Food insecurity in children and adults with food allergies. Ann Allergy Asthma Immunol 2022; 129:424-429. [PMID: 35987455 DOI: 10.1016/j.anai.2022.08.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 12/14/2022]
Abstract
Food allergy is a substantial public health concern associated with risk of severe or potentially life-threatening reactions and requiring life-altering changes in dietary habits. This increasingly prevalent health concern is associated with adverse medical, nutritional, psychosocial, and economic effects on the estimated 32 million affected individuals in the United States. Management of food allergy requires life-altering dietary modifications and constant vigilance to avoid implicated allergens to minimize the risk of anaphylaxis, which can lead to considerable anxiety and reduced quality of life. Specialized diets are expensive and often difficult to access, particularly for low-income and minority individuals with food allergy. The overlap of food insecurity with diet-treated illnesses further increases the burden on patients with food allergies and their families, with overall rates of food insecurity increasing substantially during the coronavirus disease 2019 pandemic. Universal screening to identify food insecure households and connect them with appropriate resources is a critical step in addressing unmet needs at the individual and family level. At the systems level, integrated advocacy approaches addressing the complex interplay between multiple societal issues such as poverty, systemic racism, wage inequality, housing insecurity, lack of transportation, and other social determinants of health are vital to ensure access to safe, healthy, nutritionally complete options for patients with food allergies and their families.
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Affiliation(s)
- Amy M Scurlock
- Department of Pediatrics, Arkansas Children's Hospital and Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
| | | | - Carla M Davis
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
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Neupert KB, Huntwork MP, Udemgba C, Carlson JC. Implementation of Stock Epinephrine in Chartered Versus Unchartered Public-School Districts. THE JOURNAL OF SCHOOL HEALTH 2022; 92:812-814. [PMID: 35285027 PMCID: PMC9545229 DOI: 10.1111/josh.13159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 01/28/2022] [Accepted: 01/30/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Access to unassigned epinephrine is critical for schools to treat anaphylaxis. Low socioeconomic status is associated with decreased access to epinephrine in the school setting. In and around New Orleans, physicians partner with schools to assist with stocking unassigned epinephrine autoinjectors (EAIs). New Orleans' decentralized public charter school district makes widespread adoption challenging. METHODS Physicians partnered with New Orleans decentralized public charter schools, as well as neighboring centralized public school districts, to perform training on recognizing and treating anaphylaxis, assist with the adoption of school policy for stock epinephrine, and aid with obtaining stock EIAs free-of-cost through the EpiPen4Schools® program. We used publicly available school enrollment data and our own calendar records to calculate how many children we covered with stock epinephrine per hour of physician or administrator time. RESULTS For centralized school districts, we cover approximately 4000 children with stock epinephrine per hour of time. For the decentralized district of New Orleans, we estimate covering only 400 children with stock epinephrine per hour of time. CONCLUSION Decentralized school districts reduce educational disparities, but require more time and energy to get EAIs in place than centralized school districts do.
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Affiliation(s)
- Kathryn B. Neupert
- School of Medicine, Tulane University1430 Tulane Avenue SL‐37New OrleansLA70112USA
- Our Lady of the Lake Children's Health8200 Constantin BoulevardBaton RougeLA70809USA
| | - Margaret P. Huntwork
- School of Medicine, Tulane University1430 Tulane Avenue SL‐37New OrleansLA70112USA
| | - Chioma Udemgba
- School of Medicine, Tulane University1430 Tulane Avenue SL‐37New OrleansLA70112USA
- Allergy/Immunology Fellow, National Institutes of Allergic and Infectious Diseases, National Institutes of HealthBethesdaMD20892USA
| | - John C. Carlson
- School of Medicine, Tulane University1430 Tulane Avenue SL‐37New OrleansLA70112USA
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The Role of Access and Cost-Effectiveness in Managing Asthma: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2109-2116. [PMID: 35525532 PMCID: PMC9353043 DOI: 10.1016/j.jaip.2022.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 12/21/2022]
Abstract
Background Inconsistent and unequal access to medical care is an issue that predates the COVID19 pandemic, which only worsened the problem. Limited access to care from asthma specialists and other specialists treating comorbid diseases may adversely affect asthma. Objective The purpose of this review is to identify health disparities associated with access to care for asthma, and cost-effectiveness of therapies and interventions addressing this health disparity. Methods A narrative systematic review was undertaken using MeSH searches of English language articles published in CINAHL, Scopus, or PubMed. Results A total of 725 articles were identified. Barriers recognized from the literature included access to diagnostic spirometry, access to specialists, medication formulary restrictions, and issues leading to medical nonadherence. Telemedicine, school-based health care interventions, digital applications, and non–office-based digital spirometry could be used to address these gaps in access to asthma care while potentially being cost-effective. Conclusion With the widespread adoption of telemedicine because of the pandemic, and adoption of other mobile services, we now have potential tools that can increase access to asthma care, which can help address this health care inequity. Evidence is limited, but favorable, that some of these tools may be cost-effective.
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Wong KH, Soffer GK. Characteristics and prevalence of antibiotic allergies in patients with sickle cell disease: A single-center retrospective study. Am J Hematol 2022; 97:E247-E249. [PMID: 35358357 DOI: 10.1002/ajh.26555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/02/2022] [Accepted: 03/25/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Katelyn H. Wong
- Department of Pediatrics Yale School of Medicine New Haven Connecticut USA
| | - Gary K. Soffer
- Department of Pediatrics Yale School of Medicine New Haven Connecticut USA
- Section of Allergy and Immunology, Department of Pediatrics Yale School of Medicine New Haven Connecticut USA
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Waibel KH, Perry TT. Telehealth and Allergy Services in Rural and Regional Locations That Lack Specialty Services. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2507-2513.e1. [PMID: 35777652 PMCID: PMC9280446 DOI: 10.1016/j.jaip.2022.06.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/03/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022]
Abstract
Secondary to the coronavirus disease 2019 pandemic, telehealth quickly peaked as the dominant health care modality and its use still remains high. Although allergists and health care systems adapted quickly to adopt telehealth, its increased use has both highlighted its benefits for patients and allergists and demonstrated known concerns with delivering allergy specialty care to rural and regional patient populations. With increased concentration of both patients and allergists in urban areas, the ability to provide allergy specialty care to the rural and remote population continues to remain a challenge despite the advantages leveraged through telehealth. Herein, we review aspects specific to the rural patient population, tele-allergy outcomes with these patient cohorts, and efforts, both past and present, taken at different levels within the allergy community to promote our specialty through specific telehealth modalities to address and engage the rural and regional patient.
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Bartnikas LM, Dupuis R, Wang J, Phipatanakul W. Food Allergies in Inner-City Schools: Addressing Disparities and Improving Management. Ann Allergy Asthma Immunol 2022; 129:430-439. [PMID: 35568300 DOI: 10.1016/j.anai.2022.04.035] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/28/2022] [Accepted: 04/04/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Food allergy (FA) affects approximately 8% of children in the United States. Management comprises both preventing and treating allergic reactions, which poses unique challenges in the inner-city school setting. In this article, we review the epidemiology of FA in school-aged children and management challenges and opportunities specific to the inner-city population. DATA SOURCES A literature search of the PubMed database was performed to identify published literature on FA epidemiology, FA management, school policies, disparities, inner-city, race, ethnicity, and socioeconomic status. STUDY SELECTIONS Relevant articles on FA management best practices and challenges in schools, with a particular emphasis on inner-city schools and populations and socioeconomic, racial, and ethnic disparities, were reviewed in detail. RESULTS Disparities in FA prevalence, management, and treatment exist. Additional research is needed to better characterize these disparities and elucidate the mechanisms leading to them. There is a lack of evidence-based interventions for the prevention and treatment of food allergic reactions in schools and specifically in inner-city schools, in which a greater proportion of students may rely on school food. CONCLUSION There are opportunities for partnership among health care providers, schools, and communities to address unmet needs in FA management and disparities in the inner-city school setting.
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Affiliation(s)
- Lisa M Bartnikas
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts
| | - Roxanne Dupuis
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Julie Wang
- Department of Pediatrics, Division of Allergy and Immunology, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Wanda Phipatanakul
- Department of Medicine, Division of Immunology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, Massachusetts.
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Davis CM, Jones BL. Increasing Meaningful Representation of Children in Clinical Trials to Inform Science and Achieve Health Equity. JAMA Pediatr 2022; 176:e220139. [PMID: 35311948 DOI: 10.1001/jamapediatrics.2022.0139] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Jones CJ, Paudyal P, West RM, Mansur AH, Jay N, Makwana N, Baker S, Krishna MT. Burden of allergic disease among ethnic minority groups in high-income countries. Clin Exp Allergy 2022; 52:604-615. [PMID: 35306712 PMCID: PMC9324921 DOI: 10.1111/cea.14131] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 12/19/2022]
Abstract
The COVID‐19 pandemic raised acute awareness regarding inequities and inequalities and poor clinical outcomes amongst ethnic minority groups. Studies carried out in North America, the UK and Australia have shown a relatively high burden of asthma and allergies amongst ethnic minority groups. The precise reasons underpinning the high disease burden are not well understood, but it is likely that this involves complex gene–environment interaction, behavioural and cultural elements. Poor clinical outcomes have been related to multiple factors including access to health care, engagement with healthcare professionals and concordance with advice which are affected by deprivation, literacy, cultural norms and health beliefs. It is unclear at present if allergic conditions are intrinsically more severe amongst patients from ethnic minority groups. Most evidence shaping our understanding of disease pathogenesis and clinical management is biased towards data generated from white population resident in high‐income countries. In conjunction with standards of care, it is prudent that a multi‐pronged approach towards provision of composite, culturally tailored, supportive interventions targeting demographic variables at the individual level is needed, but this requires further research and validation. In this narrative review, we provide an overview of epidemiology, sensitization patterns, poor clinical outcomes and possible factors underpinning these observations and highlight priority areas for research.
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Affiliation(s)
- Christina J Jones
- School of Psychology, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Priyamvada Paudyal
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, Brighton, UK
| | - Robert M West
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Adel H Mansur
- Birmingham Regional Severe Asthma Service, University Hospitals Birmingham NHS Foundation Trust, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Nicola Jay
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, UK
| | - Nick Makwana
- Department of Child Health, Sandwell and West Birmingham Hospitals, Birmingham, UK
| | | | - Mamidipudi T Krishna
- Department of Allergy and Immunology, University Hospitals Birmingham NHS Foundation Trust, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
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Diversity, Disparities, and the Allergy Immunology Pipeline. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:923-928. [PMID: 34999273 PMCID: PMC9255287 DOI: 10.1016/j.jaip.2021.12.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 12/30/2022]
Abstract
Disparities in health outcomes in under-represented racial and ethnic minority groups are evident in allergic/immunologic diseases and have been most completely described in asthma. The last 2 decades have not led to any substantive improvement in these disparities, with under-represented minorities (URMs) receiving worse care in several quality measures. Increasing physician workforce diversity is one strategy to improve access to care and address the health disparity problem because URM physicians more often choose to both work in clinical settings and pursue research that benefits underserved communities.
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68
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Mutic AD, Mauger DT, Grunwell JR, Opolka C, Fitzpatrick AM. Social Vulnerability Is Associated with Poorer Outcomes in Preschool Children With Recurrent Wheezing Despite Standardized and Supervised Medical Care. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:994-1002. [PMID: 35123099 PMCID: PMC9007879 DOI: 10.1016/j.jaip.2021.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/13/2021] [Accepted: 12/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Social determinants of health are associated with disparate asthma outcomes in school-age children. Social determinants have not been studied in preschool children with recurrent wheezing. OBJECTIVE We hypothesized that preschool children with recurrent wheezing at highest risk of social vulnerability would have more frequent symptoms and exacerbations when followed over 1 year, despite receiving standardized and supervised asthma care. METHODS A multicenter population of adherent preschool children receiving standardized and supervised care for wheezing was stratified by a composite measure of social vulnerability based on individual-level variables. Primary outcomes included days with upper respiratory infections and days with asthma symptom flares. Other outcomes included symptom scores during upper respiratory infections and respiratory symptom flare days, exacerbation occurrence, quality of life during the exacerbation, and hospitalization. RESULTS Preschool children at highest risk of social vulnerability did not have more frequent upper respiratory infections, respiratory symptoms, or exacerbations, but instead had more severe symptoms during upper respiratory infections and respiratory flare days, as well as more severe exacerbations with significantly poorer caregiver quality of life. Children at highest risk of social vulnerability also lived in poorer housing conditions with differing exposures and self-reported triggers. CONCLUSIONS Individual-level social determinants of health reflecting social vulnerability are associated with poorer outcomes in preschool children with recurrent wheezing despite access to supervised and standardized care. Comprehensive assessment of social determinants of health is warranted in even the youngest children with wheezing, because mitigation of these social inequities is an essential first step toward improving outcomes in pediatric patients.
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Affiliation(s)
- Abby D Mutic
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Ga
| | - David T Mauger
- Division of Biostatistics and Bioinformatics, Pennsylvania State University, Hershey, Pa
| | - Jocelyn R Grunwell
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Cydney Opolka
- Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Ga
| | - Anne M Fitzpatrick
- Department of Pediatrics, Emory University, Atlanta, Ga; Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Ga.
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Trivedi M, Pappalardo AA, Udoko M, Garg A, Phipatanakul W, Szefler SJ, Nyenhuis SM. Social Determinants of Health in Asthma Through the Life Course. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:953-961. [PMID: 35033702 DOI: 10.1016/j.jaip.2021.12.032] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/29/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
There is strong evidence supporting the influence of social determinants of health (SDOH) on the development and progression of asthma. SDOH are defined as conditions in which people are born, grow up, live, work, and age, which influence their opportunity to be healthy, risk of illness, and life expectancy. The goal of this article was to describe 2 case-based approaches (pediatric and adult) to assessing and addressing SDOH in asthma across the life course and in community settings. As asthma providers and specialists, the role of SDOH is complex in our clinical care; however, it is critical to address social needs identified through clinical care for our patients with asthma. Clinical-community partnerships, through grant and cost-sharing mechanisms with resource agencies, are necessary to ameliorate social needs for patients and their communities and have the potential to improve asthma outcomes. Although this is a unique and exciting time in health care to promote individual and population health, knowledge gaps remain, including best practices to integrate holistic SDOH care into the care of patients with asthma.
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Affiliation(s)
- Michelle Trivedi
- Division of Pediatric Pulmonology, University of Massachusetts Chan Medical School, Worcester, Mass; Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Mass
| | - Andrea A Pappalardo
- Department of Pediatrics, University of Illinois at Chicago, Chicago, Ill; Department of Medicine, University of Illinois at Chicago, Chicago, Ill
| | - Mfonobong Udoko
- Department of Pediatrics, Anschutz Medical Campus, Children's Hospital Colorado Breathing Institute, University of Colorado, Denver, Colo
| | - Arvin Garg
- Department of Pediatrics, University of Massachusetts Chan Medical School, Worcester, Mass
| | - Wanda Phipatanakul
- Division of Asthma, Allergy, and Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Stanley J Szefler
- Department of Pediatrics, Anschutz Medical Campus, Children's Hospital Colorado Breathing Institute, University of Colorado, Denver, Colo; Anschutz Medical Campus, Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), University of Colorado, Denver, Colo
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70
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Davis CM, Wang J. Reducing Health Disparities in Allergy Immunology: The Time Is Now. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:979-980. [PMID: 35397817 DOI: 10.1016/j.jaip.2022.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/18/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Carla M Davis
- Department of Pediatrics, Section of Immunology, Allergy and Retrovirology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Julie Wang
- Division of Pediatric Allergy and Immunology, Department of Pediatrics, Jaffe Food Allergy Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
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71
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Udemgba C, Jefferson AA, Stern J, Khoury P. Toolkit for Developing Structural Competency in Health Disparities in Allergy and Immunology Training and Research. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:936-949. [PMID: 35183785 PMCID: PMC9370065 DOI: 10.1016/j.jaip.2022.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 10/19/2022]
Abstract
Resources to prepare Allergy and Immunology trainees and providers to recognize and address health disparities are lacking. We designed a curriculum using interactive sessions incorporating disease-specific, evidence-based content, and a panel-based workshop with facilitated discussion to prepare Allergy and Immunology trainees to identify structural racism and health disparities. Pre-session surveys revealed that a high portion of trainees reported feeling comfortable recognizing bias and discussing health equity (n = 16, mean = 3.6/5 on a Likert scale), but felt less confident in their ability to address disparities in practice or to identify resources to care for historically disadvantaged communities (n = 16, mean = 2.9/5 on a Likert scale). The curriculum improved respondents' confidence in their ability to address these issues, with a panel-based workshop increasing attendees' scores an average of 0.65 points (n = 17, mean: pre-survey 3.31 vs post-survey 3.95). After the sessions, a toolkit was created to optimize delivery of medical education to address health disparities and define core concepts for this subject. Resources to implement these concepts in research design and recruitment efforts were included. With inadequate guidance for the incorporation of disparities-focused medical education curricula, our educational series, resources, and interactive toolkit add to existing literature to improve disparities competencies in teaching, clinical practices, and research design.
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72
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Stephen ED, Greb C, Mahdavinia M. Overcoming barriers to effective management of food-induced anaphylaxis in underserved populations through school-based interventions. Ann Allergy Asthma Immunol 2022; 129:405-406. [PMID: 35378261 DOI: 10.1016/j.anai.2022.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Ellen Daily Stephen
- Allergy/Immunology Division, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Christopher Greb
- Department of Internal Medicine, Loyola University Medical Center, Chicago, Illinois
| | - Mahboobeh Mahdavinia
- Allergy/Immunology Division, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
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73
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Perry TT, Patel MR, Li JT. Elevating Health Disparities Education Among Trainees and Physicians. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:918-922. [PMID: 35033699 DOI: 10.1016/j.jaip.2022.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/08/2021] [Accepted: 01/10/2022] [Indexed: 06/14/2023]
Abstract
Health disparities disproportionately affect patients in racial and ethnic minority groups, and these disparities are linked to economic, environmental, and social disadvantage. It is widely known that health disparities impact patients with allergic and immunologic conditions, yet universal and comprehensive training in health disparities is lacking. More robust educational opportunities are needed to fully equip trainees with tools to recognize and develop effective strategies to reduce the burden of health disparities. Also, there are no universal standards or requirements for professional medical boards in their respective maintenance of certification programs that will ensure ongoing training for practicing providers that will help them identify and manage individual or societal issues such as social determinants that contribute to health disparities. Further, the long-term impact of systematic discrimination, implicit and overt bias, and medical mistrust among populations most often affected by disparities compounds the complexity of the methods and types of training that is desperately needed to overcome health disparities. We provide a commentary on important topics that should be addressed during allergy and immunology training and beyond. We further highlight strategies and tools that should be used to tackle this important issue affecting millions of patients under our specialty care. It is past time for us to go beyond the bedside and comprehensively integrate health disparities training in our fellowship programs and in our practices.
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Affiliation(s)
- Tamara T Perry
- University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, Ark.
| | - Minal R Patel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, Mich
| | - James T Li
- Division of Allergy and Immunology, Mayo Clinic, Rochester, Minn
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74
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Teledermatology and Inflammatory Skin Conditions during COVID-19 Era: New Perspectives and Applications. J Clin Med 2022; 11:jcm11061511. [PMID: 35329838 PMCID: PMC8950226 DOI: 10.3390/jcm11061511] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The most frequent inflammatory skin diseases are psoriasis, atopic dermatitis, hidradenitis suppurativa, and acne. Their management is challenging for dermatologists since their relapsing chronic clinical course is associated with a great impact on quality of life. Nevertheless, the recent introduction of novel therapies, such as biological drugs and small molecules has been changing the history of these diseases. Methods: A systematic review of the scientific literature of case reports, case series, epidemiological studies, reviews, and systematic reviews regarding teledermatology and inflammatory skin disease. Studies were identified, screened, and extracted for relevant data following the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Results: A total of 69 cases articles were included in the review. Conclusions: As we have shown in the review, several experiences of teledermatology for patients affected by inflammatory skin diseases have been demonstrated to increase due to clinical access to hospital and specialized health care services, allowing better access to specialized dermatology care for people living in remote areas, and saving costs and money with health care.
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D’Ambrosi R, Tiusanen HT, Ellington JK, Kraus F, Younger A, Usuelli FG. Fixed-Bearing Trabecular Metal Total Ankle Arthroplasty Using the Transfibular Approach for End-Stage Ankle Osteoarthritis. JB JS Open Access 2022; 7:JBJSOA-D-21-00143. [PMID: 36159081 PMCID: PMC9489156 DOI: 10.2106/jbjs.oa.21.00143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This multicenter prospective cohort study assessed the safety and performance of the Trabecular Metal Total Ankle System (TM Ankle; Zimmer) for primary total ankle arthroplasty (TAA).
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Affiliation(s)
- Riccardo D’Ambrosi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Email for corresponding author:
| | | | | | | | - Alastair Younger
- University of British Columbia, Vancouver, British Columbia, Canada
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76
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Towards diversity in asthma pharmacogenetics. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:838-839. [PMID: 34762839 DOI: 10.1016/s2352-4642(21)00330-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
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Cook Q, Argenio K, Lovinsky-Desir S. The impact of environmental injustice and social determinants of health on the role of air pollution in asthma and allergic disease in the United States. J Allergy Clin Immunol 2021; 148:1089-1101.e5. [PMID: 34743831 DOI: 10.1016/j.jaci.2021.09.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 02/07/2023]
Abstract
There is clear evidence that exposure to environmental air pollution is associated with immune dysregulation, asthma, and other allergic diseases. However, the burden of air pollution exposure is not equally distributed across the United States. Many social and environmental factors place communities of color and people who are in poverty at increased risk of exposure to pollution and morbidity from asthma and allergies. Here, we review the evidence that supports the relationship between air pollution and asthma, while considering the social determinants of health that contribute to disparities in exposures and outcomes.
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Affiliation(s)
- Quindelyn Cook
- Division of Pediatric Pulmonary and Allergy, Department of Pediatrics, Boston University School of Medicine, Boston, Mass
| | - Kira Argenio
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Stephanie Lovinsky-Desir
- Division of Pediatric Pulmonology, Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, NY.
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78
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Angel DM, Schatz M, Zeiger RS, Sicherer SH, Khan DA. Diversity, Equity, and Inclusion: What Can a Journal Do? THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:3853-3856. [PMID: 34563739 DOI: 10.1016/j.jaip.2021.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Dawn M Angel
- American Academy of Allergy and Clinical Immunology, Denver, Colo.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Care Program, San Diego, Calif
| | - Robert S Zeiger
- Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Clinical Science, Pasadena, Calif
| | - Scott H Sicherer
- Division of Pediatric Allergy and Immunology, Jaffe Food Allergy Institute, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A Khan
- Division of Allergy and Immunology, Department of Internal Medicine, University of Texas Southwestern, Dallas, Texas
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Hvisdas C, Louisias M, Laidlaw TM, Akenroye A. Addressing disparities in biologic drug development in the United States. J Allergy Clin Immunol 2021; 148:1154-1156. [PMID: 34530019 DOI: 10.1016/j.jaci.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/11/2021] [Accepted: 09/08/2021] [Indexed: 12/13/2022]
Affiliation(s)
- Christopher Hvisdas
- Department of Pharmacy, Penn Presbyterian Medical Center, University of Pennsylvania Health System, Philadelphia, Pa
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass
| | - Tanya M Laidlaw
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass
| | - Ayobami Akenroye
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md.
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80
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Racial, Ethnic, and Socioeconomic Disparities in the Diagnosis and Management of Primary Immunodeficiencies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2926-2927. [PMID: 34246439 DOI: 10.1016/j.jaip.2021.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/22/2022]
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Clarke AE, Elliott SJ, St Pierre Y, Soller L, La Vieille S, Ben-Shoshan M. Demographic characteristics associated with food allergy in a Nationwide Canadian Study. Allergy Asthma Clin Immunol 2021; 17:72. [PMID: 34274025 PMCID: PMC8285771 DOI: 10.1186/s13223-021-00572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/28/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION We conducted a nationwide Canadian telephone survey on food allergy prevalence between February 2016 and January 2017, targeting vulnerable populations (New, Indigenous, and lower-income Canadians). OBJECTIVE To examine the independent effect of demographic characteristics on food allergy. METHODS Canadian households with vulnerable populations were targeted using Canadian Census data and the household respondent reported whether each household member had a perceived (self-reported) or probable (self-report of a convincing history or physician diagnosis) food allergy. The association between perceived and probable food allergy and demographic characteristics was assessed through weighted multivariable random effects logistic regressions. RESULTS Children, females, Canadian-born participants, adults with post-secondary education, and those residing in smaller households were more likely to report perceived or probable food allergy. Although immigrant parents self-reported less food allergy, Canadian-born children of Southeast/East Asian immigrant versus other immigrant or Canadian-born parents reported more food allergy. CONCLUSION We have demonstrated clear associations between demographic characteristics and food allergy, which may provide important clues to the environmental determinants of food allergy.
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Affiliation(s)
- Ann E Clarke
- Division of Rheumatology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Susan J Elliott
- Department of Geography and Environmental Management, University of Waterloo, Waterloo, ON, Canada
| | - Yvan St Pierre
- Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Lianne Soller
- Division of Allergy and Immunology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sebastien La Vieille
- Bureau of Chemical Safety, Health Canada, Ottawa, ON, Canada.,Food Science Department, Faculty of Agricultural and Nutrition Sciences, Laval University, Quebec City, QC, Canada
| | - Moshe Ben-Shoshan
- Division of Allergy and Clinical Immunology, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
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