Disparities in allergy testing and health outcomes among urban children with asthma

Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
The Journal of allergy and clinical immunology (Impact Factor: 11.25). 11/2008; 122(4):748-53. DOI: 10.1016/j.jaci.2008.08.001
Source: PubMed

ABSTRACT Previous research has found that treating allergies and reducing exposure to allergens can reduce asthma morbidity.
We sought to examine whether urban asthmatic children were receiving care for allergies as part of a comprehensive asthma management plan.
A cross-sectional study, consisting of a parent-reported questionnaire, was conducted in 26 randomly selected New York City public elementary schools during the 2002-2003 school year.
In a sample of 5,250 children aged 5 to 12 years, 13.0% were found to have current asthma. The prevalence of allergy diagnosis was 21.0%. Less than half (47.3%) of the subjects with current asthma reported a physician's diagnosis of allergies. The frequency of a reported allergy diagnosis varied with race/ethnicity, ranging from 14.4% in Mexican American children to 67.9% in white children. Only 54.9% of asthmatic children with an allergy diagnosis reported allergy testing. Children from lower-/middle-income households and children with public forms of health insurance were the least likely to report testing (adjusted odds ratios, 0.18 and 0.46). Higher frequencies of reported allergy testing were associated with education on allergen avoidance, use of allergy medications, lower exposure to household allergens, and lower prevalence of wheezing.
Many children do not receive comprehensive asthma treatment that includes management of allergies and education on avoidance of household allergens. Lower reported allergy testing might indicate lower access to medical care among middle-income families who are ineligible for public programs but who do not have the income to access higher-quality care. Interventions aimed at improving medical care and adherence to treatment guidelines are necessary to decrease asthma morbidity.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: Asthma is the most common chronic condition of childhood, affecting 9.1% of all American children. The prevalence and morbidity of asthma among children in the United States have increased dramatically over the past 3 decades. More than 6 million children currently have asthma, leading to 205,000 pediatric hospitalizations and 697,000 emergency department visits each year (Akinbami et al., Pediatrics 123(Suppl 3):S131–45, 2009). Asthma develops through the interaction of genetic factors with environmental exposures. Strong evidence has linked exposure to dust mites, cockroaches, rodents, mold, and pet dander to the development of sensitization to allergens and subsequent asthma incidence and morbidity (Institute of Medicine, Clearing the air: asthma and indoor air exposures. Washington, DC: National Academy Press, 2000; Institute of Medicine, Damp indoor spaces and health. Washington, DC: National Academy Press, 2004; Platts-Mills et al., J Allergy Clin Immunol 96(4):435–40, 1995; Sporik et al., Thorax 54(8):675–80, 1999; Dales, Am J Epidemiol 134(2):196–203, 1991; Rosenstreich et al., N Engl J Med 336(19):1356–63, 1997; Zock et al., J Allergy Clin Immunol 110(2):285–92, 2002). Exposure to indoor allergens is widespread (Salo et al., Environ Health Perspect 117(3):387–91, 2009). In the United States, disadvantaged and minority populations are disproportionately affected by asthma (Gold and Wright, Annu Rev Public Health 26:89–113, 2005; Asthma and Allergy Foundation of America and National Pharmaceutical Council, Ethnic disparities in the burden and treatment of asthma. Washington, DC, 2005). Relative to wealthier and white populations, they have higher asthma prevalence and experience more serious impacts such as severe attacks leading to emergency department visits and hospitalizations (Aligne et al., Am J Respir Crit Care Med 162: 873–7, 2000; Litonjua et al., Pediatr Pulmonol 28(6):394–401, 1999; Weiss and Gergen, Chest 101(June suppl):362S–7S, 1992; Call et al., J Pediatr 121:862–6, 1992; Lang and Polansky, N Engl J Med 331:1542–6, 1994; Grant et al., Curr Opin Pulm Med 5(1):27–34, 1999; Eggleston, Immunol Allergy Clin North Am 18:75–84, 1998). The current asthma prevalence among blacks is 25% higher than non-Hispanic whites. The emergency department visit rate among blacks is 4.6 times higher than that among whites, the hospitalization rate 3.4 times higher, and the mortality rate 3 times higher (Akinbami, Asthma prevalence, health care use and mortality: United States, 2003–05. Accessed 21 May 2010). Many factors interact to produce these inequities (Eggleston, Immunol Allergy Clin North Am 18:75–84, 1998; Grant et al., Curr Opin Pulm Med 5(1):27–34, 1999). As much as 40% of the excess asthma risk in minority children may be attributable to exposure to residential allergens (Lanphear et al., Pediatrics 107(3):505–11, 2001). Being poor or a person of color is associated with increased rates of sensitization to several asthma-associated allergens found in homes (Christiansen et al., J Allergy Clin Immunol 98(2):288–94, 1996; Willies-Jacobo et al., J Allergy Clin Immunol 92(4):630–2, 1993; Gelber et al., Am Rev Respir Dis 147(3):573–8, 1993; Sarpong et al., J Allergy Clin Immunol 97(6):1393–401, 1996; Lewis et al., J Allergy Clin Immunol 107:615–22, 2001; Strachan, Toxicol Lett 86:199–203, 1996; Huss et al. Ann Allergy 72(2):173–7, 1994; Eggleston, Clin Rev Allergy Immunol 18(3):311–24, 2000). Low-income children and children of color are more likely to live in substandard housing. Living in substandard housing leads to exposure to allergens and higher rates of allergen sensitization (Eggleston, Immunol Allergy Clin North Am 18:75–84, 1998; Huss et al., Ann Allergy 72(2):173–7, 1994; Kitch et al., Environ Health Perspect 108(4):301–7, 2000). Features of substandard housing such as excessive moisture and dampness, poor ventilation, crowding, pest infestations, deteriorated carpeting, and structural deficits are associated with high levels of indoor asthma triggers (Hyndman, Making connections between housing and health. Putting health into place. Syracuse, NY: Syracuse University Press, pp. 191–207, 1998). Exposure to combustion products from unvented stoves can induce asthma symptoms (Eisner et al., Thorax 57:973–8, 2002). A strong parallel thus exists between exposure to asthma triggers and the differential exposure of disadvantaged populations to hazards in the outdoor environment (e.g., toxic waste dumps or freeways) – a hallmark of environmental racism (Northridge and Shepard, Am J Public Health 87(5):730–2, 1997).
  • [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this article is to provide a useful index to English-language, scientific publications (2007-2008) related to pediatric asthma management. The authors first surveyed abstracts to identify studies likely to affect the practice and research direction of asthma and allergy educators. To accomplish the goal of providing a comprehensive overview of the literature, only brief descriptions of selected studies are provided. The authors have not attempted to describe and critique research designs or discuss implications of findings. Expert panel reports are specifically designed to accomplish these important goals. However, approximately 5 years lapse between expert panel reports (or updates). In the interim, the authors believe that a year-by-year review of new research will be useful to many people. The draft version of Expert Panel Report 3 was released in January 2007, so the review began with that date. The authors hope this approach will stimulate interest in and improve access to the literature, facilitate collaboration, and perhaps inspire new thinking that could move the asthma and allergy educator community along a little faster in the common effort to reduce asthma burden among children.
    01/2011; 2(1):29-43. DOI:10.1177/2150129710380725
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Skin testing is a mainstay in allergology, and its importance is increasing in several fields. The ability to choose the most suitable technique according to the clinical setting is an advantage for the medical team. Objectives: To describe in detail an alternative technique of the coetaneous allergy test (skin scrape test) conceived as a variation of the former skin scratch test; to evaluate its value as a tool for diagnosis of immune sensitization; and to com-pare its accuracy with the skin prick test. Methods: The skin scrape test and skin prick test were performed side by side with the same allergen extracts in 162 hu-man subjects classified in two groups according to the known presence or absence of serum specific-IgE to these aller-gens. Results: The sensitivity of the skin scrape test to detect immediate reactions was 85.0%. The sensitivity of the skin prick test was 86.5%. The sensitivity of both techniques analyzed together as a unique procedure was 94.2%. The specificity of the skin scrape test was 90.1%.The specificity of the skin prick test was 72.9%.The specificity of both tests analyzed to-gether as a unique procedure was 70.5%. Conclusions: The skin scrape test is an alternative and complementary technique for allergic skin testing, and it is able to detect IgE-specific immune sensitization without the disadvantages of the skin scratch test. The skin scrape test has simi-lar outcomes to the skin prick test.
    The Open Allergy Journal 04/2013; 6:9-17. DOI:10.2174/1874838401306010009


Available from
Sep 15, 2014