The Disparity Crisis in Asthma & Allergy Care: What Every Clinician Needs to Know

This webinar was recorded August 25th, 2026

The numbers are stark: 28 million Americans live with asthma, yet Black Americans are three times more likely to die from it. Puerto Rican children carry a 21.2% cumulative asthma prevalence by age five. Black children under 14 died from asthma at rates eight times higher than white children between 2007 and 2009. After 35 years of clinical guidelines, evidence-based therapies, and national health objectives, we remain, in the words of Dr. Cherie Y. Zachary, ACAAI President and Chair of the College’s Diversity Task Force, “a bit stuck.”

In a recent Advances webinar presented in partnership with the American College of Allergy, Asthma & Immunology (ACAAI), Dr. Zachary delivered a masterclass in the structural, environmental, and clinical forces perpetuating inequitable outcomes across asthma, allergic rhinitis, atopic dermatitis, and food allergy. Her message was unambiguous: these disparities are real, measurable, and preventable.

Structural Racism Is a Clinical Variable

What drives a Black child in a redlined neighborhood to develop asthma by age five at nearly three times the rate of a white peer? The answer isn’t biology alone — it’s cockroach and mold allergen exposure in deteriorating housing, proximity to diesel highways, concentrated poverty, and decades of discriminatory urban planning. Dr. Zachary cited research demonstrating that for every 100 meters further from a major roadway, children reported 29% fewer asthma symptoms and were 20% less likely to have poor asthma control.

Social determinants of health operate on a dose-response curve: individuals experiencing five or more adverse social factors carry nearly a three-fold higher odds of asthma. Clinicians who treat the lungs without addressing the zip code are treating half the patient.

Implicit Bias in the Exam Room

Perhaps the most uncomfortable data point Dr. Zachary presented: 70% of physicians demonstrate implicit preference for white patients over Black patients — influencing communication, non-verbal behavior, and treatment recommendations. Black patients are more likely to have asthma severity underestimated, resulting in less inhaled corticosteroid prescribing and inadequate flare-up counseling.

Race-based spirometry correction compounds this further. Dr. Zachary was emphatic: clinicians must adopt Global Lung Initiative (GLI) standards immediately, as race-specific equations have historically masked disease severity, delayed diagnoses, and — in the most serious cases — denied patients access to lung transplantation.

Evidence-Based Pathways Forward

The evidence for intervention is equally compelling. Community health worker programs at Boston Children’s Hospital reduced hospitalizations by 79% and ED visits by 56%. School-based asthma management programs improved medication adherence across disproportionately affected populations. Telehealth meaningfully improved outcomes in underserved communities.

Dr. Zachary’s prescription for individual clinicians is equally actionable: take an implicit bias assessment, screen for social determinants of health using validated tools, advocate with local and federal officials, prescribe generic epinephrine auto-injectors, and — critically — listen before you prescribe.

The Bottom Line

Health disparities in allergy and immunology aren’t an unfortunate footnote — they represent an estimated $2.4 billion in unnecessary asthma spending alone. Closing this gap demands action at every level: clinical, institutional, and political.

Speaker:
Cherie Y. Zachary, M.D., FAAAAI, FACAAI, FACP, FACDS

Dr. Zachary is a board-certified allergist/immunologist and internist with more than 30 years of experience in academic medicine and private practice. A graduate of Howard University College of Medicine, she completed her residency in Internal Medicine at the University of Minnesota and fellowship training in Allergy and Immunology at Northwestern University and Children’s Memorial Hospital in Chicago. Dr. Zachary is a Fellow of the AAAAI, ACAAI, ACP, and ACDS and has held numerous leadership roles focused on health equity, diversity, and access to care. She currently serves as President of the American College of Allergy, Asthma & Immunology (ACAAI) and is Chair of the College’s Diversity Task Force.

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 an ACAAI member, you can obtain CME through the member portal for this Advances webinar.

A certificate of attendance is available for all registered attendees.
No other continuing education (CE) credit is available for this webinar.

Sponsored by the American College of Allergy, Asthma and Immunology