ACAAI Report Highlights AD, Allergy Care Disparities and Proposed Solutions

Disparities in care among individuals who have atopic dermatitis (AD) and/or other allergic conditions prompted the American College of Allergy, Asthma and Immunology (ACAAI) last year to examine the issue more closely. Their focus was on patients with skin of color, and a summary of the findings appeared recently in Annals of Allergy, Asthma & Immunology.

ACAAI members (200 responded to the 24-question survey request, which represents 4.6% of the total membership), physicians, and advocacy leaders were interviewed, and the ACAAI also held a roundtable discussion “to further explore the challenges and discuss potential solutions.” The survey was available from December 28, 2021, through January 9, 2022; most respondents (68%) were White and in private practice (73%) in a suburban location (61%).

“The roundtable focused on challenges that people with skin of color who have these conditions often experience based on their skin type, their comfort level with health care providers, where they live, and many other sociodemographic factors,” according to a statement on the group’s findings.

On a scale of 0 to 100, respondents noted an average awareness level score of 73 for the challenges people with skin of color face to receiving adequate care for AD and food allergies.

The report included the top 10 reasons the study’s patient population has trouble accessing and receiving care equivalent to that of other races/ethnicities. These reasons gathered from the survey are the following:

• Health care provider accepts Medicaid coverage: 69%
• Inadequate awareness/education on symptoms and conditions: 68%
• Insufficient or no insurance coverage: 58%
• Treatment cost: 53%
• Access to a local specialist who can identify AD in black and brown skin: 39%
• Safe food cost: 39%
• Access to information that can facilitate condition management: 35%
• Access to safe foods: 32%
• Testing cost: 30%
• Supplemental Nutrition Assistance Program (SNAP)/Women, Infants, and Children (WIC) programs that limit access to certain foods: 25%

In addition, the authors noted, 74% of survey respondents reported inadequate and unhelpful federal, state, local, or association levels of resources “in addressing the identified challenges in the diagnosis and treatment of AD and food allergy for people with skin of color,” the investigators noted.

Following the roundtable discussions, and after incorporating survey findings and data from the interviews, 10 solutions were proposed to make inroads against AD and food allergy care disparities:

• Explore ways to enroll more people with skin of color into clinical trials
• Recruit more people with skin of color into medical school, particularly into the specialty of allergy, asthma, and immunology
• Increase outreach to high school students
• Increase awareness and education among specialists
• Increase awareness and understanding among primary care providers—and leverage community outreach to educate patients
• Advocate for revised WIC and SNAP policies to increase access to safe foods
• Develop a photo library of atopic dermatitis in people with skin of color
• Create culturally appropriate patient education materials and partnerships to reach communities of color
• Work toward longer appointment times for patients who need them
• Leverage this research and the roundtable participants’ insights to increase awareness and create change

These are not hard-and-fast mandates, the report authors emphasized, but instead jumping-off points for further dialog they hope will initiate real change “by health care systems, advocacy organizations, policymakers, payers, the allergy and asthma community, and academia in the lives of people with skin of color and mitigate racial disparities in AD and food allergy.”

Reference

Corbett M, Allen A, Bobo N, et al. Proposed solutions by the American College of Allergy, Asthma, and Immunology and advocacy experts to address racial disparities in atopic dermatitis and food allergy. Ann Allergy Asthma Immunol. Published online December 17, 2022. doi:10.1016/j.anai.2022.12.017