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Udemgba C, Burbank AJ, Gleeson P, Davis CM, Matsui EC, Mosnaim G. Factors Affecting Adherence in Allergic Disorders and Strategies for Improvement. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00632-9. [PMID: 38878860 DOI: 10.1016/j.jaip.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/29/2024] [Accepted: 06/04/2024] [Indexed: 07/25/2024]
Abstract
Addressing patient adherence is a key element in ensuring positive health outcomes and improving health-related quality of life for patients with atopic and immunologic disorders. Understanding the complex etiologies of patient nonadherence and identifying real-world solutions is important for clinicians, patients, and systems to design and effect change. This review serves as an important resource for defining key issues related to patient nonadherence and outlines solutions, resources, knowledge gaps, and advocacy areas across five domains: health care access, financial considerations, socioenvironmental factors, health literacy, and psychosocial factors. To allow for more easily digestible and usable content, we describe solutions based on three macrolevels of focus: patient, clinician, and system. This review and interactive tool kit serve as an educational resource and call to action to improve equitable distribution of resources, institutional policies, patient-centered care, and practice guidelines for improving health outcomes for all patients with atopic and immunologic disorders.
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Affiliation(s)
- Chioma Udemgba
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md; University Medicine Associates, University Health, San Antonio, Tex.
| | - Allison J Burbank
- Division of Pediatric Allergy and Immunology, University of North Carolina School of Medicine, Chapel Hill, NC
| | - Patrick Gleeson
- Section of Allergy and Immunology, Division of Pulmonary, Allergy, and Critical Care Medicine, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pa
| | - Carla M Davis
- Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Elizabeth C Matsui
- Center for Health & Environment: Education & Research, University of Texas at Austin Dell Medical School, Austin, Texas
| | - Giselle Mosnaim
- Division of Allergy and Immunology, Department of Medicine, Endeavor Health, Glenview, Ill
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Sansweet S, Jindal R, Gupta R. Food allergy issues among consumers: a comprehensive review. Front Nutr 2024; 11:1380056. [PMID: 38595790 PMCID: PMC11002200 DOI: 10.3389/fnut.2024.1380056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/23/2024] [Indexed: 04/11/2024] Open
Abstract
Food Allergy (FA) is a growing global public health concern. In the United States alone, 8% of children and 11% of adults have a convincing FA (symptoms consistent with an IgE-mediated reaction to a specific allergen). Given the significant prevalence of this condition, the objective of this mini-review is to illustrate the many dimensions of life that are impacted among those with FA. Summarizing findings from a breadth of current literature, we present how FA affects social, psychological, and economic-related quality of life. With this informative review, we endeavor to bring increased awareness to these issues and help cultivate a better future for individuals with FA.
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Affiliation(s)
- Samantha Sansweet
- Center for Food Allergy and Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ria Jindal
- Center for Food Allergy and Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Ruchi Gupta
- Center for Food Allergy and Asthma Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
- Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
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Lanier K, Scherzer R, Coletta C, Ogbogu PU, Risma KA, Redmond M. Factors Influencing Career Choice of Allergy and Immunology Fellows-in-Training: A Work Group Report of the AAAAI Program Directors Assembly Executive Committee. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:627-632.e4. [PMID: 38300169 DOI: 10.1016/j.jaip.2023.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/02/2023] [Accepted: 10/12/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND As the burden of allergic and immunologic disease continues to increase, there is increased demand for a larger Allergy and Immunology (AI) subspecialty workforce. The field must prioritize the expansion of our workforce and the recruitment of exceptional and diverse trainees to ensure the vitality of the specialty. Although the AI fellowship match has traditionally been competitive, recent trends in fellowship applications have demonstrated fewer applicants per fellowship position. This trend has made recruitment a priority on the agenda of the national AI societies. OBJECTIVE To elucidate key factors influencing the decision to choose the field of AI by querying fellows-in-training. METHODS A survey was created and distributed yearly to fellows-in-training from 2017 to 2021 to identify factors influencing a career choice in AI. RESULTS Approximately 59% of respondents rotated with AI in residency and 35% in both medical school and residency. Most respondents reported having a mentor in the field before fellowship, and many had their first exposures to AI during medical school (40%) or residency (32%). Most respondents decided to pursue AI during residency. The most common factors that influenced the decision to pursue AI were work/life balance, clinical aspects of the field, mentorship, and research opportunities. CONCLUSIONS Our data suggest that the decision to pursue a career in AI often occurs during residency training and is motivated primarily by work/life balance, clinical aspects of the field, and clinician mentorship. Our survey results could provide guidance to AI training programs on strategies to recruit exceptional and diverse trainees.
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Affiliation(s)
- Kasey Lanier
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Division of Allergy and Immunology, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Rebecca Scherzer
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio.
| | - Christian Coletta
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio; Division of Allergy and Immunology, The Ohio State Wexner Medical Center, Columbus, Ohio
| | - Princess U Ogbogu
- Division of Pediatric Allergy, Immunology, and Rheumatology. University Hospitals, Rainbow Babies and Children's Hospital Cleveland, Cleveland, Ohio
| | - Kimberly A Risma
- Division of Allergy and Immunology, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Margaret Redmond
- Division of Allergy and Immunology, Nationwide Children's Hospital, Columbus, Ohio
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Perry TT, Grant TL, Dantzer JA, Udemgba C, Jefferson AA. Impact of socioeconomic factors on allergic diseases. J Allergy Clin Immunol 2024; 153:368-377. [PMID: 37967769 PMCID: PMC10922531 DOI: 10.1016/j.jaci.2023.10.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/13/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
Allergic and immunologic conditions, including asthma, food allergy, atopic dermatitis, and allergic rhinitis, are among the most common chronic conditions in children and adolescents that often last into adulthood. Although rare, inborn errors of immunity are life-altering and potentially fatal if unrecognized or untreated. Thus, allergic and immunologic conditions are both medical and public health issues that are profoundly affected by socioeconomic factors. Recently, studies have highlighted societal issues to evaluate factors at multiple levels that contribute to health inequities and the potential steps toward closing those gaps. Socioeconomic disparities can influence all aspects of care, including health care access and quality, diagnosis, management, education, and disease prevalence and outcomes. Ongoing research, engagement, and deliberate investment of resources by relevant stakeholders and advocacy approaches are needed to identify and address the impact of socioeconomics on health care disparities and outcomes among patients with allergic and immunologic diseases.
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Affiliation(s)
- Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark.
| | - Torie L Grant
- Johns Hopkins University School of Medicine, Baltimore, Md
| | | | - Chioma Udemgba
- National Institute of Allergic and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Akilah A Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Research Institute, Little Rock, Ark
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Bingemann TA, Hernandez-Trujillo V. Changing with the times-learning to pivot as an academic allergist. Ann Allergy Asthma Immunol 2023; 131:288-289. [PMID: 37661168 DOI: 10.1016/j.anai.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 06/05/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Theresa A Bingemann
- Departments of Allergy, Immunology and Rheumatology and Pediatric Allergy and Immunology, University of Rochester School of Medicine, Rochester, New York.
| | - Vivian Hernandez-Trujillo
- Nicklaus Children's Hospital, Miami, Florida; Herbert Wertheim School of Medicine, Florida International University, Miami, Florida; Allergy and Immunology Care Center of South Florida, Miami Lakes, Florida
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Jacobs S, Brar K, Nowak-Wegrzyn A, Louisias M. Why You Should Care About Implicit Bias as an Allergist-Immunologist and Ways We Can Address It. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1718-1724. [PMID: 36972799 DOI: 10.1016/j.jaip.2023.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 02/06/2023] [Accepted: 03/12/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Samantha Jacobs
- Department of Pediatrics, New York University School of Medicine, New York, NY
| | - Kanwaljit Brar
- Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY
| | - Anna Nowak-Wegrzyn
- Allergy and Immunology, Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Children's Hospital, New York, NY; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Margee Louisias
- Division of Allergy and Clinical Immunology, Brigham and Women's Hospital, Boston, Mass; Division of Immunology, Boston Children's Hospital, Boston, Mass; Department of Medicine, Harvard Medical School, Boston, Mass.
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Udemgba C, Sarkaria SK, Gleeson P, Bryant-Stephens T, Ogbogu PU, Khoury P, Apter AJ. New considerations of health disparities within allergy and immunology. J Allergy Clin Immunol 2023; 151:314-323. [PMID: 36503854 PMCID: PMC9905264 DOI: 10.1016/j.jaci.2022.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/09/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022]
Abstract
The pandemic, political upheavals, and social justice efforts in our society have resulted in attention to persistent health disparities and the urgent need to address them. Using a scoping review, we describe published updates to address disparities and targets for interventions to improve gaps in care within allergy and immunology. These disparities-related studies provide a broad view of our current understanding of how social determinants of health threaten patient outcomes and our ability to advance health equity efforts in our field. We outline next steps to improve access to care and advance health equity for patients with allergic/immunologic diseases through actions taken at the individual, community, and policy levels, which could be applied outside of our field. Key among these are efforts to increase the diversity among our trainees, providers, and scientific teams and enhancing efforts to participate in advocacy work and public health interventions. Addressing health disparities requires advancing our understanding of the interplay between social and structural barriers to care and enacting the needed interventions in various key areas to effect change.
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Affiliation(s)
- Chioma Udemgba
- National Institute of Allergic and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Sandeep K Sarkaria
- Section of Allergy and Immunology, Department of Pulmonary & Critical Care, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Patrick Gleeson
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Tyra Bryant-Stephens
- Department of Pediatrics, Division of General Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Princess U Ogbogu
- Division of Pediatric Allergy, Immunology, and Rheumatology, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, Ohio; Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Paneez Khoury
- National Institute of Allergic and Infectious Diseases, National Institutes of Health, Bethesda, Md
| | - Andrea J Apter
- Section of Allergy & Immunology, Division of Pulmonary, Allergy, & Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa.
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Disparities in the Diagnosis and Management of Anaphylaxis. Curr Allergy Asthma Rep 2023; 23:13-19. [PMID: 36454450 DOI: 10.1007/s11882-022-01053-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to characterize health disparities impacting the recognition and treatment of anaphylaxis. RECENT FINDINGS Previous research has identified major health disparities related to atopic conditions including asthma, atopic dermatitis, and food allergies (FA); however, disparities related to anaphylaxis have yet to be examined in depth. We found widespread health disparities in the incidence and severity of anaphylaxis, as well as in the management of allergies (particularly food allergies) that place individuals at risk of anaphylaxis. Sociodemographic factors are associated with numerous negative health outcomes related to anaphylaxis. We highlight several key steps that must be taken to address these disparities.
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Izadi N, Saff RR. Allergy and immunology interest and exposure among US medical students and residents. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2022; 1:305-308. [PMID: 37779536 PMCID: PMC10509886 DOI: 10.1016/j.jacig.2022.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/28/2022] [Accepted: 08/02/2022] [Indexed: 10/03/2023]
Abstract
Background Despite the immense burden of allergic disease, the allergy and immunology (AI) workforce in the United States continues to shrink. Fellowship applications for AI have declined sharply in contrast to those in more popular specialties. Objectives Here we have sought to evaluate the current level of AI interest and exposure among early trainees in the United States, as well as their perspective on how to improve interest in the field. Methods An 18-item questionnaire was sent via e-mail list-serve to 2 groups: (1) mostly residents in the American Academy of Allergy, Asthma & Immunology (AAAAI) with interest in AI and (2) medical students in the American Medical Student Association (AMSA) whose specialty interests were not known. Results In the AAAAI group, 412 members were surveyed and 70 responses were received. In the AMSA group, 4778 members were surveyed and 47 responses were received. More individuals in the AAAAI group interacted with their AI division than in the AMSA group (73% vs 19% [P < .001]). On average, the AAAAI group would "probably" pursue AI whereas the AMSA group who would "definitely not" do so (P < .001). Almost all of the AMSA group (94%) had heard of AI before, but only 19% of them interacted with AI at their program. Regarding ways to increase interest in AI, the top responses for both groups were clinical exposure via electives and shadowing (a score of 4.69 on a 5-point scale) and didactic exposure via lectures and presentations (a score of 4.29). Conclusions Our study suggests that increasing AI opportunities for didactics and clinical exposure may lead medical students to develop more interest in pursuing the field. Some strategies are also discussed.
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Affiliation(s)
- Neema Izadi
- Division of Clinical Immunology and Allergy, Children’s Hospital Los Angeles/Keck School of Medicine of the University of Southern California, Los Angeles, Calif
| | - Rebecca R. Saff
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Boston, Mass
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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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Tepler E, Wong KH, Soffer GK. Health disparities in pediatric food allergy. Ann Allergy Asthma Immunol 2022; 129:417-423. [PMID: 35476967 DOI: 10.1016/j.anai.2022.04.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/15/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To review the current literature regarding the health disparities in the prevalence, diagnosis, and management of pediatric food allergy and discuss possible interventions. DATA SOURCES Literature search of PubMed and Google Scholar databases regarding pediatric food allergy and health disparities. STUDY SELECTIONS Original research articles, reviews, and guidelines on health disparities in pediatric food allergy were included in this review. RESULTS The overall prevalence of food allergy appears to be increasing and disproportionately affecting minority groups. Racial and socioeconomic disparities are evident across all aspects of food allergy care: diagnosis, prevention, acute management (eg, access to epinephrine autoinjectors, visits to emergency department), and long-term management (eg, oral immunotherapy). Children of minority populations and those of low socioeconomic status are at a greater risk of food insecurity, which is further exacerbated by the high cost of allergen-free foods and limited support from food assistance programs. CONCLUSION Racial, ethnic, and socioeconomic disparities in food allergy among children in the United States are evident and negatively affect the outcomes of children with food allergies. Active efforts to decrease racial and socioeconomic disparities, through education, research, and advocacy, will be important to help improve health outcomes in food allergy for all children, regardless of their race, ethnicity, or socioeconomic status.
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Affiliation(s)
- Elizabeth Tepler
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut.
| | - Katelyn H Wong
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Gary K Soffer
- Section of Allergy and Immunology, Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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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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