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Health Disparities in Allergy, Asthma and Immunologic Diseases (Recording)

Webinars

This webinar was recorded on July 16, 2024

Asthma and allergy treatment has seen remarkable innovation in the last 25 years, but this progress is still not reaching everyone. More than 25 million Americans have asthma and 50+ million have allergies. These conditions disproportionately impact Black, Hispanic/Latino and Native American communities. Social, economic, and environmental factors often play a key role in causing asthma and allergy disparities. Join us as we explore disparities in allergy, asthma and immunologic diseases and how to best help under-resourced communities.

Speaker:

  • Nancy Joseph, DO

Dr. Nancy Joseph is double board certified in general pediatrics and allergy/immunology and is currently based in Massachusetts. She is a consultant and medical advisor for the Allergy & Asthma Network. Dr. Joseph is a member and fellow of the American College of Allergy, Asthma and Immunology and the National Medical Association (NMA) in which she is active locally and nationally. She has collaborated with the NAACP speaking about COVID-19 during the height of the pandemic and has been featured on NMA talks as an expert panelist discussing asthma in the African American community. Dr. Joseph has been awarded Top Physician Under 40 by the NMA. Dr. Joseph hosts the “How Do You Medicine” podcast highlighting healthcare professionals doing medicine their way.

This Advances webinar is in partnership with the American College of Allergy, Asthma & Immunology. ACAAI offers CMEs for physicians for this webinar. If you are a member of ACAAI, you can obtain CME through the member portal for Advances webinars.

All attendees will be offered a certificate of attendance. No other continuing education credit is provided.

CME is available through ACAAI for this webinar.

Sponsored by the American College of Allergy, Asthma and Immunology

Logos for the ACAAI and ask the allergist program

Transcript: While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

Catherine: Hello, everyone. You’re going to allow some time for some other folks to join us, so in the meantime, let me know where you are from. Put it in the chat so I can see where in the world you are.

Catherine: OK, were going to go ahead and get started. Hello everyone. Thank you for joining us today. My name is Catherine Blackwell and I am the chief health equity officer for allergy and asthma network. Welcome to this afternoon’s webinar. We are in for a real treat today with Dr. Nancy Joseph as our presenter. We have a few housekeeping items before we start today’s program. First, all participants will be on mute for the webinar. We are going to record today’s webinar and posted on our website within a few days. You can find all of our recorded webinars on our website at allergyasthmanetwork.org. You can scroll down to the bottom of the page to find our recorded in upcoming webinars. This webinar is going to be about one hour including time for Russians. We are going to take those questions at the end of the webinar but you can put your questions in the Q&A at any time. The Q&A box is at the bottom of your screen. So we will have somebody monitoring the chat if you have questions or need some help during your going to get to Rez many questions as we can before we conclude today’s webinar. This webinar is in partnership with the American College of allergy Atlanta immunology. They offer CMEs for physicians and attendance credits for all others. You can create a free account and obtain CME for attendance credits through the member portal for advance webinar. All attendees will be offered a certificate of attendance and no other continuing education is provided. A few days after the webinar, you are going to receive an email with supplemental information and a link to download the certificate of attendance. We are going to also try to add the link to the certificate in the chat. So let’s get started. The base topic is health disparities and allergies, asthma and immunologic diseases. Allergy treatment has seen remarkable innovation in the last 25 years. But the progress is still not reaching everyone. More than 25 million Americans have asthma and 50 million plus have allergies. These conditions disproportionately affect and impact black, Hispanic, Latino and Native American communities. Social, economic and environmental factors often play a key role in causing asthma and allergy disparities. So join us as we explore disparities in allergy, asthma and immunologic diseases and how to best help under resource communities. It is my distinct pleasure to interest our speaker Dr. Nancy Joseph. Dr. Joseph is a double board certified and general pediatrics and allergy immunology and is currently based in Massachusetts. She is a consultant and medical and Pfizer for the allergy and asthma network. Dr. Joseph is a member and fellow of American College of allergy, asthma and immunology and the National medical Association in which she is active locally and nationally. She has collaborated with the NAACP speaking about COVID-19 during the height of the pandemic and has been featured on NMA talks as an expert panelist discussing asthma in the African-American community. Dr. Joseph has been awarded top physician under 40 by the NMA. Dr. Joseph postS the — postS — HOSTS the ” how do you medicine” podcast. Thank you so much for being here and I will turn it over to you now.

Dr. Joseph: Thank you so much for having me, Kathryn. Thank you so much to the allergy and asthma network for having me and talking about this very important topic. So today we are going to touch on everything. Typically we touch on either asthma or allergies but today we are going to add another element which is the immunologic diseases. People touch a little bit on immunologic diseases first and then we will go from there. Let me make sure my slides advance first. Perfect. Wonderful. So as Catherine said I am double board certified which means I am a pediatrician and allergist and I see people in various — that means in the allergy and asthma world and in the in the knowledge of world I see everyone and in the general medicine world, I only see pediatrics. Another thing that I to put on ‘s, if you want to connect with me in the digital space, my Instagram is typically where you will find me. What I will do is I will put that in the chat now because I always forget. So I will put that there and I am on LinkedIn as well and I will get that in the chat as well. That way I don’t forget because I will inevitably used to. — do so. Let me know if you didn’t see it, can’t see it, and I will repeat it. After the presentation, get started. I have no disclosures at this time. Some learning objectives, we are really going to hit on some stance because it is really important to use stats to help bring the impact to life, to really understand the impact of health disparities, why health disparities is important and why we are having several webinars about it and why it is important to come together to talk about it and bring about action steps as to how we can best move forward to move the needle to more health equity. We are going to examine the disparity immunologic diseases, some inclusive treatment plans and possible interventions. So that if the general learning objectives and now let’s talk about where we are headed more detailed. First we will define what health disparities is. Again, we will jump into statistics about various diseases and we will talk about how health disparities are really impacting allergic diseases. I will give you some resources, and possible interventions. So it is a jampacked presentation, so feel free to put some questions in the Q&A or if you need me to go back to another slide later, I can do that as well.

So first, we are having this whole webinar about health disparities and certain diseases, but let’s first identify what they are. First, health disparity really just means a lack of health equity. By definition, health disparity is health differences linked to economic, social and environmental disadvantages. So they are nonmedical factors that influence health outcomes according to the CDC and an article that had the definition specifically of differences linked to social and environmental disadvantage. So health disparities affect every aspect of society and it affects social determinants of health. That is why it is very important to not only recognize it, but trust it. I am a more visual person. Things solidify better with me when I see them. And so education access and equality, neighborhood environment and economic instability, interventions in these areas is really what impact health equity. So I really wanted to use this figure to really bring home the fact that health equity and healthy quality are not the same. Equality means if you look at these figures, if we were talking about the quality that all has one box under their legs. But that is not helpful, because what is causing one person not to reach the apple is not the same as the other, so getting them one box each would not be sufficient for some and would be too much for the other. Vs. equity allows you to have equal access or not equal, but equitable access to health care. So you get what you need with equity vs. just trying to give the same thing to everyone despite them not needing the same thing. So health equity would look like this person needs three boxes, this person needs two, this person needs one. So now let’s jump into health disparities by disease type. We will talk about immunologic diseases first, but the first step is trying to understand what that even is. Often times when I say that I am in allergy immunologist, the immunology part is what people have the most questions about, what it even is. And a lot of people have heard of and allergist, and a lot of people know what it is to be allergic to something, but I find that immunology falls by the wayside often so I really wanted to take this time to talk about what immunology even is and what the immune system is. Immunology if the study of the immune system. The immune system is what I like to call our soldier. It is the system that protects you against things. S

o it is your body’s defense. Daily we have things trying to invade us and we need our soldiers, our immune system to really protect us and make sure that things don’t go into our system that don’t need to be there. Invaders, if you will. Bacteria’s, virus. In general there is immune system, but then when your body starts to attack itself it is now called autoimmune. So typically, autoimmune diseases fall into the category of other specialists, that type of thing. And then when your immune system fails, it is an immune deficiency. That is where an immunologist like me would come in. I call that man down. There all or a part of it that is either absent or not working properly. That is what immune deficiency is called. Sometimes you are born with that and sometimes you acquire it. So that denotes whether or not you have a primary immune efficiency or a secondary immunodeficiency. A primary immune deficiency typically is inherited, starts in childhood. We’ve heard of bubble boy disease, people who have different parts of the immune system that have multiple wives of their immune system missing which makes them incredibly susceptible to disease that you and I would just, our soldiers would just fight no problem. We wouldn’t even know the difference but those individuals get sick really easily, and that would happen since childhood and that is typically primary immunodeficiency. Secondary immunodeficiency is an acquired thing. I wasn’t born with it and somehow I picked it up along the way. One of the most common ways of developing acquired immunodeficiency is if something , a medication of some sort caused a come eyes of that particular immune system or compromise a bat as chemotherapy. We know chemotherapy attacks the bad cells but in general it also attacks other cells that are good guys. That can lead to immunodeficiency and might lead to you seeing someone like me, and immunologist. So that if the nuts and both of what immunology is. Let’s talk about primary unit efficiency in numbers because that is the disparity lens that we are going to use. Primary immunodeficiency affects over 6 million people worldwide.

One in 10,000 people in the world have a primary immunodeficiency. It is two times as high the likelihood of primary immunodeficiency in white individuals vs. black and Hispanic individuals, but the caveat is it is underdiagnosed in black and Hispanic individuals, so because minorities are underrepresented in studies, what happens is we see this number that is twice as high, but with the understanding that those numbers are skewed because there is a lack of rivers and take in minorities in these studies, minorities tend to be underdiagnosed anyways, so this is probably the only place where they would be very few places in this presentation where you will see the number of this disease is twice as high in whites vs. black and Hispanic individuals. However it comes with the caveat that the number is what it is, but we don’t really know the accurate number because there is under diagnosis in minority populations. To that is the immunodeficiency part of this presentation. Our first allergic disease we will talk about is food allergy. The food allergy, first, 10% of adults in the U.S. have food allergy. 19% of them believe that they have a food allergy. So there’s 9% that may think they have food allergy but when they get evaluated and see the allergist, it is proven that it is not a food allergy at all, so that is another reason or a reason to make sure you see a specialist because you may be avoiding foods unnecessarily and it may not be the issue so it is important to see a specialist. And in children, one in 12 children in the U.S. have a food allergy. So the numbers are different whether we talk about children vs. adults and we will talk a little bit more about that later. So let’s talk about allergy and the black community. Food allergy is four times more frequent in African-American individuals and they have a higher rate of death from food allergies.

There’s higher levels of various allergy cells in the black community including a cell called IGE. IGE is an allergic cell. This varies cells around your body. Part of the immune system is called immunoglobulins. That word was thrown around a lot in the hype of COVID because that is what you use, the IGG is what you used to see if you’ve been exposed to something. It your memory immunoglobulin so there are the IgG test for COVID and people were getting to see if they had been exposed. That is where immunoglobulins come in. Your body’s memory system to say I’ve seen this before. So African-American children have peanut allergy that is present eight times higher rate than their white counterparts. And there is a higher rate of food allergy, corn, shellfish and fish and a three-time higher rate of having shellfish allergy in African-American children. They are more likely to have multiple food allergies and African-American children with allergic diseases or a parental history have a high instance of shellfish allergy. This is all from a study that was found with Dr. Davis and another study in 2007 that was done saw these health disparity numbers, these staggering numbers where you need to things like eight times higher rate. That is why I love putting numbers on the slides. It really helps bring home how huge the health disparity really is when we talk about the black community, but especially in children. So let’s talk about food allergy and research.

The genetics of that is still being studied. There is some genetic varianc that occurs more frequently in African-American people. The findings are helpful, but the findings don’t incorporate certain populations as much or very many individuals on that population, and that’s a problem. They are five times more likely to be referencing food allergy literature and African-American individuals and access to care which we will talk about when it comes to health disparities. Access to care plays a role. There is wonderful study, the Ford study that is helping combat this and so I thought it would be good to spend a little bit more time on that study to really highlight some good work that is being done. So the Ford study — forward study had white and African-American children ages zero to 12 with food allergies. And they found that African-American children have three times higher chance of having a shellfish allergy and 2.5 higher chance of having a regular fish allergy. There’s less than 50% of them with a confirmatory testing or were evaluated by an allergist and they have a higher rate of food related anaphylaxis ER visits. So this particular statistic talking about 50% of these individuals got confirmatory testing. So imagine all these African-American children have food allergies by history but only 50% of them were able to get that confirmed. That leads back to the disparity we talked about, the ball, when we talked about 10% of individual that actually have a food allergy VS. 19% believing they have a food allergy. There’s already a difference in the actual food allergy and the belief thereof. But then we only have 50% of them getting to see the allergist to get confirmatory testing. So there may be individuals who are unnecessarily avoiding things or maybe their reaction is not allergic in nature and more studies are meeting, more testing is needed. But those individuals are not getting that test.

That is really an important thing to bring up, to bring light to to help hone in this disparity between not only diagnosis, but also access and seeing specialists. So this is a food allergy action plan. As someone with a food allergy should always have an action plan. That is to say, what should you do should you have a reaction? and what should you give minor reactions, VS. major reactions like hives and tongue swelling, difficulty breathing, throat tightness, that type of thing. That is what he food allergy action plan comes in handy. It is a guide to what to do. But research shows more way children are being given those action plans and African-American children. So when they do see the specialists, they are not even given the action plan, which is unfortunate because that is really a tool to anybody taking care of that child, daycare, babysitters. For people to know what to do and when. So let’s talk a little bit about when we talk about disparities, not only diagnosis, but disparities in access. When you are food allergic, it is important to have access to safe food, but food insecurity really brings a challenge to that. A food insecurity is limited access to good quality food and a lower quantity of food. Allergy adds the network can look on their website for ideas of how to help with those food costs because a lot of times, allergic foods cost more than nonallergic, foods that are not allergy friendly. Food diversity.ORG has a network and it can connect individuals with consistent and reliable sources of safe foods which can make a world of difference if you or anyone you know have food allergies. You know it can make a world of difference to know that this is a reliable and safe source for food allergy — allergen safe foods.

Definitely that website is down here. Again, if you noticed there is only one D. So another entity that’s really making a huge impact in the food energy world — allergy world is the food quality initiative. It is founded by Emily Brown, a cofounder of something called free From market that has a mission to provide people diagnosed with celiac disease equal access to food that they need to be healthy regardless of race, economic status. Really just helping to comment the disparities in access of allergy safe foods and help fight food insecurity and inequity. Or lack of health equity when it comes to food. It is a great organization and she had the market which really is an online platform with over 1500 nutrient dense foods that you can order to your door. It helps people with diabetes, high blood pressure, any gastrointestinal disorders, that type of thing. It is a personalized, diet-specific food delivered straight to your door. So this is the website. When you get there, you will see this, and it asks you to create an account or if you already have one, you can just login. Just a great source. So that is the food allergy part. Wanted to give you guys that and access to that. Now let’s talk about eczema. Let’s start with some numbers. First will be talk about eczema in general, it affects more than 10% of children, or than 5% of adults. When you have one allergic disease, food allergy, asthma, seasonal allergies, all of those are allergic diseases. It increases the risk of developing eczema. Typically it is one of the diseases of the call the atopic March. People who are prone to allergic diseases will have eczema first and then develop another allergic disease, typically food allergies and then they will develop asthma or seasonal allergies you are just marching through the diseases.

That’s talk about eczema in the black community. Atopic dermatitis is a technical term. Talking about specifically in this presentation, I’m using it to eczema, but just know that sometimes the vernacular may be a little bit different. If you have any questions, with say you see your doctor and they are using a different type of dermatitis, make sure you ask them so what is that exactly? I’m saying this because sometimes in the medical world, we can get lost in the vernacular. We might not quite get it, so I wanted to make sure to plug that in here so that you guys know that in this presentation I’m using eczema and atopic dermatitis interchangeably. Sometimes that’s not the case in other settings. So we will talk about eczema. It affects black individuals at a higher rate than white individuals. Like children are less likely to cedarwood colleges, twice as likely to get diagnosed with atopic dermatitis and twice as likely to have a severe form. They have twice as many office visits, three times as much missed school all because of their eczema. Really staggering numbers for this particular disease. It has a higher disease burden in the black community. Again, they are more prone to have more severe disease and of course, that lasts longer. Decreased genetic risks for atopic dermatitis, yet they have an increased likelihood of having severe disease. Black children are almost six times less likely to have the mutation that causes eczema. There is a genetic mutation that makes you more prone to having severe eczema. Black children are six times as likely to have that. So what we take away from this is genetics is not the full picture. It’s not even the majority of the picture. Though the extent of the genetic effect is unclear, due to a lack of diversity in research, there’s a lack of diversity in research so we don’t know the extent to which genes affect eczema in the black community, all we know if the genetic dictation that we do know leads to severe eczema, lack children are less likely to have it. So that lead you to believe that there’s other issues at hand really causing this disparity. So it is definitely not something we can just point the genetics as to why these numbers are so much higher and so staggering. We talk about health disparities when it comes to eczema. It is multifactorial.

Socioeconomic status being one of the factors. For socioeconomic status leads to more severe atopic dermatitis. It’s a multidimensional factor, all factors, structural racism, the country needs health disparities, social determinants of health. And then physical environment. A study showed that black children in highly segregated communities tend to have more severe eczema. So then again, this is not even genetics. We know that already. But there are social constructs that are in place that then lead to physical manifestations. We talk about segregation. A highly segregated community alone, atopic dermatitis. So let’s talk about what it even is. We talked about the numbers, the disparities of the numbers, but let’s quickly take a pause to talk about what is eczema, what is atopic dermatitis? It is an inflammatory disease. Relapse and remitting. It is just a waxing and waning of nature. It is an inflammatory process and can be inherited or acquired. We talk a little bit about the genetics already. We talked about the genes and the less likelihood of black children to have that. The skin integrity and the effects of eczema on that. Eczema is a breakdown of skin integrity. You are decreasing the skin barrier function and what happens is you have more water loss. Your skin is compromised because it is holding water like it is supposed to. Enhanced water loss leads to dry skin. Dry skin leads to itchy skin. Now in general, you scratch because you itch and you it’s because you scratch. I know you guys up for that before. It really is just kind of a never-ending futile cycle. It could end, but I mean without treatment or addressing it. So I really just want to be on this site for just a couple of seconds. I really wanted to talk about what it looks like in various skin and how important it is to note that eczema looks different on various skin. It is important to note because sometimes they can be under-diagnosed depending on the skin color. It is definitely very itchy, is red lesions that can be plaques or patches. Depending on the age, it tends to be in flexor services. That means dry, scaly patches in adults. But chronic atopic dermatitis leads to thick and leathery skin which is what you see here which we call in the medical world like edification. All that really decreases your sleep, so lack of quality sleep and lack of quality of life. Something disturbing the, especially chronically is certainly sure to affect your quality of life.

But also notice when we talk about redness, if we are depending on redness to diagnose a particular disease, that is a faulty way because darker skin, you are seeing the redness. If you are depending on the redness you’re going to misdiagnose a population. So we talked about the quality of life that has, the effect that it has on particular individuals but more specifically, it does also affect the mental health of the caregiver. It impacts your mental health whether you are an adult or child and adults with a topic tenders are found to have increased propensity to have anxiety and prescient and kids have increased risk of developing ADHD. So affects everywhere. And that in general there’s a lack of understanding of the disease, especially as a chronic disease. The perception of others may be this person just never takes care of their skin or they never moisturize without the understanding that this person has an increased propensity to have dry skin and having that scalyness. It is not that person’s fault. It is not that person doesn’t take care of themselves, is the increased propensity. A lack of understanding of what eczema is and what really gives way to that and the dryness and things like that really can affect the perception of others and really how that person feels, how you make that person feel that those have eczema. So I really just wanted to show what eczema can look like in various skins of color. In general, if you are worried about something, talk to your doctor. You want to make sure you advocate for yourself. It is better to ask than not to ask. So treatment costs, cost is a barrier when it comes to equity. Black patients with atopic dermatitis spend more out-of-pocket for medication, ER visits and lab tests. Again, we talked about the staff that they have increased chance of having — going to the ED because the eczema. Of course they spend more out-of-pocket money when it comes to ER visits. It’s because of a decreased health care access and under diagnosis.

Waiting for redness to diagnose, you’re going to underdiagnosed. There’s a lack of access to health care which increases your chance of going for something that maybe if you had better access or better treatment options or better access to a primary care doctor or some specialist, maybe there would be fewer visits, better management of that particular disease. So it is really all interconnected. So there are some programs just in general. There are some programs that can help save the cost of medications, prescription pharmacy programs. We’ve all known sometimes buying something like Benadryl or Zyrtec, that is the name brand. Often times, that is cheaper than having to buy the particular name brand. Particularly when the web to see a specialist when it comes to eczema, you just want to make sure that you know the particular food figure of that. In general, talk to your doctor. They will help you decide if you need to see a specialist and if so, which one to see. Just know that they are there for you. Work in conjunction to help determine with the most appropriate thing is. So I’m going to go through this preparing for a doctor’s visit here. But know that I really wanted to put it at the end, but I’m going to kind of drive home to help the equity piece of this presentation more at the end. It just happens to get better here. But just in general when we are talking about how to get ready to see a doctor, things you should know, often times as a specialist we may feel overwhelmed. As a specialist you’re just not sure what they need to know and maybe they’re asking you questions and you think gosh, I don’t know all this, I didn’t know you are going to ask me all this. Things you want to note so that when you are prepared when you go and see a doctor, especially a specialist, you are prepared for those questions because that specialist, we are just not meeting as a new page and severe going to ask you more specific questions, detailed questions. This is my cheat sheet. First timeline is important. When did your symptoms start? Doctors don’t need specifics. They don’t need to know you started on January 15 at nighttime. They just need to know in general. About five months ago. About five years ago. That type of thing. And you want to note any triggers.

Give us as much information as you can come more specific information. I notice when I do this, it gets worse. When I do this, it gets better. That way it helps us rule out certain things and then help us with a list of possibilities for your particular symptom. Also you want to make sure you keep track of what thank you tried. My doctor tried a cream, it didn’t work. My doctor tried an antihistamine, it didn’t work. My doctor tried whatever the pill is, a lot of times in your particular chart, the patient chart will either have the medication that the doctor has given sometimes if you go to the same system your specialist can see that and sometimes they might not be able to. This is what I was on and it did work or I didn’t work and important family history. Maybe this is the time to ask your mom did anybody ever have any issues with eczema or sometimes have they had any issues with itchy skin or did they have any skin conditions? It may be possible that you never talked about or thought to defend it very well. So that is my Chi-Chi for you for a doctor’s visit specifically. Especially a specialist. So now it’s jump into some ads numbers real quick. I’m going to go through this kind of fast because I want to talk about some health disparity issues and interventions. Why is it important? In terms of health disparity, the answer is 26 million Americans live asthma. It is the number one cause of missed school days and when it comes to asthma and health equity, it affects African-American people more, especially in underserved areas. The prevalence in population is increasing. As income decreases, asthma prevalence increases. Let’s talk about specifically the numbers when it comes to asthma African-American individuals.

African-American individuals are 30% more likely to have asthma. There are three times more likely to go to the emergency room. Three times more likely to succumb to an asthma death. We talked about that with food allergies, right? If you are more likely to have more severe disease, you’re more likely to get elevated care. Emergency room visits are increased and when it comes to asthma in children, the stat is even more staggering. African-American children are seven times more likely to have an asthma death than their non-Hispanic white counterparts. These numbers are our reasons we are even having the conversation when it comes to African-Americans and asthma. When it comes to health disparities. Health disparity is important, I know that. I like numbers because numbers don’t lie. Numbers can drive home. Numbers didn’t drove home while it is important to increase the representation in general whether we’re talking about research, the clinical setting, immunities. We want to make sure that we bring home to you why these talks are important. So what can be done? I will talk more in general later, but what can be done about asthma in general? First, awareness is key. Without knowledge, the people perish. I want to increase awareness of asthma education. Education of asthma and allergic diseases and the impact they have. There are some partnerships that we have. The National medical Association, which is near and dear to my heart. It is an organization that really helps combat disparities and represents over 25,000 African-American or physicians of African dissent and it really helps with health equity and really helps create a voice for a minority patient. Of course there the EPA. So you want to make sure that if you want to go to these organizations, websites, that really helps. When you need to know what work they’re doing and how you can get involved, the asthma alley network as a program which has been cross a to patient. Talks like this help with the process because it increases with increasing health awareness, awareness of health disparities. We want to be a voice for health equity. Getting involved with your community and with research. Seen where in the — medical Association you can be of help.

Legislation is important. The asthma allergy network does a call on the day of the hill which is where we advocate for legislation that really helps move the needle forward comes to health equity in the allergy asthma space. Help allergy practitioners, legislation helps outages practitioners. And it helps us help you, and helps us better serve you. Going to baby a summit, conferences for us as a provider is helpful but for you, this various support groups you can join. That help you learn not only about what the problem is, but help you move the needle forward in terms of being a voice. I’m going to close out with really talking about the big picture here when it comes to health equity. As the stance alone demonstrate the need for equity especially in children, because children are the future, but the talk about more specific representation, health equity and how we can address the issues. Representation matters, people like me, less than 5% of us are black. The JAMA found that the residence of a black physician in a particular county improves many aspects of the community’s health. Just for presence. That doesn’t mean they have to be the doctor. None of that. Just the presence of a black physician in a particular county improves adherence to treatment, means that people are more likely to get decreased care and there is decreased mortality of the black patient. The first two was not just black patients, but specifically a decrease in mortality. So representation matters is why we are having these talks. Now talking about health disparities I wanted to close out with how we get here and how we get out of here. First let’s look at this visual. I saw this and was like, this is amazing.

Really talking about how we got here. Structural inequities. Race and that is the, language barriers. Again, there is up and downstream factors that led to health disparities. Researching institutional barriers, we talked about that. Decreased diversity and research personnel. Decreased diversity in research participants in general. There’s is built environmental exposures. As redlining, housing, segregation. At school, again, they are a problem when we talk about allergic diseases. Increase allergens are not helpful with that. Structural barriers for caret delivery of allergy and immunology, there’s a decreased diagnosis and treatment. We talked about how African-Americans are less likely to be diagnosed in general with if and allergic diseases. We also talked about how in the less likely to get something like a food allergy action plan. Access decreases diagnosis and decreases treatment. You can’t trade something that you would are not diagnosed. You are thinking I am looking for redness for eczema and underdiagnosed, they are not being treated for they really have. So decreased access to specialists is an issue we talked about. Less than 5% are black. There’s attention to psychosocial needs that are not met. Increased prevalence that leads to adverse health outcomes downstream. The increased prevalence of different diseases we talked about. So therapeutic hesitancy, I’m headed to detectives because I don’t know about it, there is a trust issue here. So all of these are the road upstream and downstream, factors on the road to how we got to our health disparities and how we are we are. This article really brings home some suggestions as to how we can intervene. It is important for us to sometimes come from a different background, so what we think in terms of our biases, we have these micro aggressions that we aren’t aware of. Things like that.

Equity training helps with that. Participatory environment of education and education of at-risk communities, active recruitment of diverse pricing quote and research. Recruiting staff from different backgrounds. If you have a diverse staff increasing and research or recruiting for research, it increases the chance that you might have a diverse population of participants. Advocacy and policy work which we talked about. That would help increase access to clean and safe housing. Reinforcement — reimbursement services we spoke about in terms of food insecurity’s things like that. Tracking care gap data really helps us bring home at risk populations are at risk populations, tracking that data to help us get the information we need. Of course there are many other things we can do, but I felt like these were really great proposed interventions this article that really helped pay, this is where we been, these are things that could really help. This incredible health equity to have a disparity situation that we are in. I wanted to make sure I leave at least 10 minutes for questions if you have any size you want me to go back to. Also, let me know but with that I will bring it back to Catherine and I will stop sharing my screen.

Catherine: Wow. That was a mod of great information as always. There’s a couple things that I want to bring up and this might even be a topic for your next podcast, I don’t know. But you talked about the alarming numbers of four times more frequent in African-Americans with regards to food allergy. 30% more children at risk in the black community. And what I have seen out in the field as well as being a health care professional, being a nurse myself, and being an African-American female, a lot the folks in our community, they don’t even really know about food allergies. If they eat something, not that they don’t know about it, but they just interpret it a different way. If they eat something that does not agree with them they will say he gave me indigestion, let me take a Pepcid or a Tom’s. I ate this tomato with these strawberries and I broke out. Yeah, I’ll just take a Benadryl and they just keep on going. And then it comes in play where they don’t have access to an allergist. They go to their primary care physician. You have a lot of the folks that live in underserved communities in a food desert where they always Chinese restaurants, McDonald’s or whatever, and you have a single mother with four or five children, she just wants to get her children fed. So she just does the best that she can. The good veggies, fresh produce, that stuff is not available to them, so it is a whole lot of social determinants of health that impact this and it is such a problem. You know I want to save the world just like you do. Where do we start? How do we bring more awareness about food allergies because that is really crucial in the community, and I just don’t see the uptake.

Dr. Joseph: Right. You brought the answer, and the answer is awareness. The first step to solving a problem is knowing that you have a problem. So the first step to solving health equity is even knowing what it looks like, what it is, where it is, that type of thing. And food allergies, again, you can’t help someone’s food allergy if they didn’t know they had a food allergy. So my first step is really to educate. This is what allergy is, this is what allergy isn’t. What is happening is the mislabeling. Some people think they have allergies, they don’’t. Some didn’t think they have allergies, they do. So you may not report it but if you don’t think it is an allergy and then asking about your medical history, now we are talking about something else. All this time you had shellfish allergy. There is a lack of family history. Because maybe your mom and your grandma both had food allergies. All this time you had a whole generational history of allergic diseases that you have no idea of. That type of thing. First you want to increase awareness, you want to increase education of what it is to be allergic, what it is to have allergy, and we really want to destigmatize allergy because a lot of time there is a stigma when it comes to allergy, when it comes to epinephrine autoinjector’s. There are people who say I don’t need one. Well, be given to you because of their risk. And having anaphylactic reaction. You don’t get car insurance because you were accident-prone. You get car insurance because you could have an accident. That type of thing. Because we know the risk of it happening is high enough that we want to prevent it. When it comes to asthma, there is a stigma against the word asthma. There are individuals that have history incredibly consistent with asthma, but if you don’t tell the person the diagnosis of asthma they will say no. That word has never been said to me. But they are on dual action inhalers, albuterol. So if we are treating it like asthma but we are not telling the patient they have asthma, what are we really doing? Are we really just saying sometimes I get difficulty breathing when I have calleds — colds? A proper diagnosis of asthma helps re-stratify a person when you talk about COVID and having something like Paxlovid. But if you were never told you had asthma, you never think you have asthma, if you don’t think you have asthma you can’t properly put yourself in a particular risk category at the height of the pandemic. So knowledge is really the first step and without that, everything crumbles. If you don’t have knowledge and awareness, we are in the uphill battle. And before I forget, I wanted to bring up the other webinar that is happening, and that is my fault, everyone. And going to quickly share my screen for no other reason but to say we are having a webinar that is coming up that I wanted to bring up. You guys probably can see my screen, I will put it in. The next is on childhood asthma, August 21. I’m sorry, smart therapy July 25 at four clock p.m. Eastern. Smart therapy and other patient-centered approaches. After that there’s childhood asthma August 21. And then there’s August 27 with seasonal allergens. So I wanted to make sure I said that and I will stop sharing my screen now, but I wanted to let you guys know that there’s two July webinars and there’s one August webinar coming up so you guys are hopping on.

Catherine: One of the questions, are there any cultural or dietary practices that could influence allergy and asthma management?

Dr. Joseph: Pardon me about allergy and asthma management. Human practices that would keep them from taking their inhalers or tell me a little bit more about..? I mean, that person who posed the question. Is it on the Q&A?

Catherine: Yeah. That is all the person said.

Dr. Joseph: Let me see if they have it in the chat.

Catherine: I’m sorry, it is in the chat.

Dr. Joseph: OK it is in the chat. Can you give me a little bit more specific that can influence allergy and asthma management? Allergy and asthma in general, but tell me about what you mean by influence allergy and asthma management specifically. Someone asks you are welcome, yes. That is important. I don’t specifically on hand have the numbers specifically in public housing, but what we do know is that the environmental factors that tend to be associated with that increase the risk for asthma, how close you live to a highway, urban population or urban settings. But specific numbers I do not have. Someone wants me to list the upcoming webinars again. I will do that. Let me make sure that I answer that question. I will just generally answer that dietary practices question because I don’t think they give me any. Sometimes depending on the culture, it could just be an allergen field diet. Maybe you have a heavy seafood diet or something like that. In general, culturally that could make it harder for somebody with a shellfish allergy or fish allergy to participate in various cultural practices and that type of thing. That could really affect one of the keystones of management which is avoidance. It’s really hard if you are gluten allergic and your culture is really heavily rice, it is really hard. Sometimes you feel left out and things like that and there’s cultural practices that make it hard from that perspective. In terms of asthma, we know there’s a lot of cultural practices that tree asthma historically and that may not be as effective for that particular individual and it may be hard to try to convince maybe one person in your family wants you to manage asthma this way but you are like, I saw my doctor and they want me to use these. That is what I mean. That is one of the aspects of the stigmatizing asthma and do stigmatizing — de-stigmatizing the treatment use for inhalers, understanding that your health practitioners are trying to work with you to help you. We aren’t trying to dismantle anything that has helped you in the past or dismantle any beliefs, we are really just trying to say research has shown these are really helpful in terms of inhalers and things like that, and we know what is in them because they are monitored by the FDA so I really want you to use this and complementary medicine. We are not against that at all. We just want to make sure we do the best we can to adequate the manager asthma but I can understand there are some cultural practices that may be something that needs to be addressed when we are talking about holistic practice and holistically treating something. I hope that answers your question. Wonderful. In the chat there is a link to the next webinar which is July 26. So wonderful, wonderful. Perfect.

Catherine: So we are at the top of the hour, actually a little but after the hour.

Dr. Joseph: Did we miss any questions, and so sorry.

Catherine: No, everything is great, you answered everything. Thank you so much. This has been really informative, just want to go over the webinar is coming up again so people can hear it as well. First up as Dr. Joseph mentioned is smart therapy and other patient-centered approaches toward asthma management which is going to be presented by Dr. Angela Hogan on July 25 at 4:00 Eastern standard Time. Then we will come back to Dr. Dave Dugas on August 21 at 4:00 p.m. Eastern standard Time to talk about childhood asthma and how to teach children how to use their inhalers which is going to be great. We are going to walk — welcome Dr. Maitland to discuss seasonal allergies and optimizing treatment for each patient. So you will receive an email from Zoom in a few days with a link to the recording, and additional resources. So thank you again from all of us at allergy and adds the network and join us as we work every day to bring better together and close the gap in disparities and improve health equity. Have a good afternoon.

Dr. Joseph: Goodbye, everyone.