February 26, 2022
6 minute read
PHOENIX – Racial disparities affect every aspect of clinical care for food allergies, from prevention and diagnosis to insurance coverage and the diversity of the workforce providing treatment.
The Food Allergy Outcomes Related to White and African American Racial Differences (FORWARD) study has published several papers exploring where these disparities come from and how best to address them.
Andrea Pappalardo, MD, FAAAAI, assistant professor of medicine and pediatrics at the University of Illinois at Chicago, discussed these findings along with her own experience as the asthma director of the community outreach program Coordination of Healthcare for Complex Kids (CHECK ) at the American Academy of Allergy, Asthma & Immunology Annual Meeting.
Healio spoke with Pappalardo, who is also the director of Mobile Care Chicago, to find out more.
Helio: What are the main racial disparities in food allergy treatment?
Papalardo: There are many. First, there is a higher prevalence of food allergies in people of color, especially black and African American children, as well as in comorbidities, especially relating to asthma. There is also a difference in that black people are more likely to die from an allergic reaction.
Overall, people of color not only have an increased likelihood of having a food allergy and additional factors in their atopic disease milieu, but they are also more likely to die or have a worse and more severe reaction. .
Another aspect of these disparities relates to knowledge and understanding of access to care and to subspecialists. There are a lot of interactions in multiple layers of disparities that make the overall experience more difficult for people of color.
Helio: Do these disparities impact food allergies more than other allergies?
Papalardo: Yes. There is an increased rate of various food allergens, usually like shellfish, among African Americans and blacks, which could be a problem. But I don’t believe anything is isolated, because kids don’t get just one thing. Everything is on a spectrum.
Helio: What are the biggest The factors conduct these disparities?
Papalardo: One would be racism, and unfortunately it interacts with all these other factors, like food security. The social determinants of health would be another. A third would be the ability to access the right education and provider for you, and that can mean many different things.
Healio: east insurance cover one of barriers in access to care?
Papalardo: Absolutely, and it interacts not only with race and ethnicity, but also with socioeconomic status. Previous research has compared whether the same patient would see the same specialist whether they had private insurance versus Medicaid or public insurance, and there was a significant difference.
We see it in the ivory towers. We work with academic institutions and we accept many public insurances. But it is really difficult to access for families. That’s why I like the model of taking a provider and giving families access to care where they live, work and play, because it’s a beautiful concept that helps overcome some of these issues .
Helio: What should allergists do to start reducinging these disparities?
Papalardo: Physician advocacy can help providers understand, first, that there is a problem. I think that’s starting to happen, which is fantastic, but it’s a relatively new area in food allergy.
You recognize where things are not equal and you try to examine yourself, look at your practice, your day-to-day lifestyle and what you can potentially do. Simply open your eyes to what is happening in front of you and potentially find your comfort zone in what you feel good about doing to take the next step towards fairness.
Healio: Primary care physicians are the first point of contact for many of these families. What can they do to improve care?
Papalardo: It really starts with primary care. Much of what we do in the FORWARD study is great work, but these are children who have already had access to the specialist. So we really need to work on primary care.
What early introduction practices are they talking about? How to prevent food allergies? When children first develop a food allergy, how can we refer them to the subspecialist they need and deserve?
Perhaps a patient navigator, a community health worker, or some sort of care coordination model within primary care that can help these patients from the beginning to the end of their lives across the spectrum of food allergies and allergic diseases could potentially help.
Helio: Another the first point of contact for many families would be the school nurse. What kinds school policies would help to improve these disparities?
Papalardo: This is fine with me, as I do school work on asthma and allergies. The National Association of School Nurses and I would say we need a school nurse in every school. When a school nurse only spends a few hours a week at a school she is assigned to and has multiple schools at once, how could she know enough information to help properly handle an emergency then that she is not physically there?
So, first, we need advocacy within schools. We need to have a school nurse in every school, and she needs to have access to a stock of emergency medications as well as coded epinephrine that is accessible without a person’s name attached to it.
We need to understand the latest in recommendations for food allergies, asthma and other atopic diseases in the school setting — and the school nurse is the ambassador. Otherwise, we cannot make a meaningful change to the school approach to care.
Helio: How? ‘Or’ What can providers engage in community partnerships?
Papalardo: There are many ways. Food allergy research and education, the Food Equality Initiative, and various other groups offer ways to start thinking about how we can connect the dots and start working together. But they are not the only ones.
By working within your communities, your own advocacy organizations within your own cities, your school districts – from the ground up from the beginning in your own region – you can do a lot more than you think.
Healio: Should physicians contact schools in their city and local chapters of their professional organizations?
Papalardo: Absolutely, and I’ve found that to be very successful in my own work. Talk to regional superintendents. Talk to school districts, nurses out in the field, families. It can really help you understand what’s going on in your own specific area.
What a lot of these groups like the Allergy and Asthma Foundation of America and others are doing is fantastic. But then we come to how this child navigates the school system on his own. Working with families in the community context where our children live and where you work will be the first, easiest way to connect.
Helio: Where are you going for the funding to support these programs?
Papalardo: There isn’t enough, so it has to be a worthwhile investment, and we believe everyone who does this work is worth it. This work is a necessity. To promote health outcomes and achieve health equity across all populations, we need to pay attention to this.
Act rather than talk. If you want to have a more diverse clinician workforce, if you want more diverse representation in clinical trials, you have to invest in the communities in which you live and in the communities in which you practice. I think that’s one of the main areas we want to focus on.
Healio: Previously, you talked about the need for a more diverse and diverse clinician workforce.ity in universities and research to help eliminate these disparities. What are the keys to achieving this diversity?
Papalardo: It’s a pipeline. I’m an allergist and immunologist, but I spend a lot of my time working in medical school. I took on a teaching role for exactly that. Get allergy and immunology in the minds of medical students early on. There is more diversity in medical schools than we have seen before.
There are also people who spend a lot of time reaching out to high school students. I do this with the children I see in our mobile clinic. Recognize that there is potential out there and let these young people know that anyone can do this, you can do that, you can be successful.