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

Abstract

Background

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

Objective

We aimed to determine whether socioeconomic conditions, as measured by the Area Deprivation Index (ADI) and insurance status, or racial/ethnic self-identity were associated with risk of food allergy diagnosis (DFA), evaluation by an allergist, or objective food allergy testing among high-risk children with atopic dermatitis.

Methods

This is a retrospective cohort study of pediatric patients with physician-diagnosed atopic dermatitis who had received primary care at a single urban academic tertiary care center between 2009-2022. Statistical analysis in SPSS utilized Chi Square, ANOVA, and logistic regression.

Results

3,365 pediatric subjects identified as 41.3% non-Hispanic Black, 33.9% Hispanic, 6.9% Asian, and 14.9% non-Hispanic White. Hispanic children with AD and DFA were significantly less likely to be evaluated by an allergist than White or Asian children (65.9% vs. 82.8% and 80.3%, p=0.001 and p=0.02). Non-Hispanic Black children with AD and DFA were more likely to have no objective food allergy testing than White children (20.9% vs. 12.1%, p=0.04). The White and Asian children were more likely to undergo the thorough combination of both blood and skin testing for DFA than Black or Hispanic children (15.5% and 22.4% vs. 7.1% and 7.9%, respectively – p=0.007, p=0.00005, p=0.03, 0.0008)

Conclusion

Labeling at-risk young children with food allergy without thorough objective testing can impact their nutrition and quality of life. Barriers to equitable evaluation of food allergy diagnosis should be further investigated and addressed.