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

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

Objective: To determine whether socioeconomic conditions, as measured by the area deprivation index and insurance status, or racial/ethnic self-identity was associated with risk of FA diagnosis (DFA), evaluation by an allergist, or objective FA testing among high-risk children with AD.

Methods: This is a retrospective cohort study of pediatric patients with physician-diagnosed AD who had received primary care at a single urban academic tertiary care center between 2009 and 2022. Statistical analysis in SPSS (IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0, Armonk, NY) used χ, analysis of variance, and logistic regression.

Results: In a total of 3365 pediatric subjects, 41.3% identified as 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 = .001 and P = .02). Non-Hispanic Black children with AD and DFA were more likely to have no objective FA testing than White children (20.9% vs 12.1%, P = .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 = .007, P = .00005, P = .03, P = .0008).

Conclusion: Labeling at-risk young children with FA without thorough objective testing can affect their nutrition and quality of life. Barriers to equitable evaluation of DFA should be further investigated and addressed.