Expanding access to asthma and allergy care for the underserved

May 2017

Rates of allergy and asthma continue to increase in the US and globally

A worrisome upward trend in the prevalence of asthma and allergies continues in the US and globally. In the US, the prevalence of asthma has increased from an estimated 3.1% in 1980 to about 7.6% in 2017 - more than a 2.5-fold increase in a little over three decades. Food and skin allergies have also increased by about 50% and 69%, respectively, over a period of 12 years. Food allergies are now estimated at 5% in adults and 8% in children and appears to be increasing.

The burden of asthma and allergy disproportionately affects those at a lower socioeconomic status

Evidence suggests that the burden of asthma and allergy disproportionately affects those at a lower economic status deepening existing inequities. Although ethnicity and genetics explain some of the differences in asthma and allergy prevalence and severity among populations, socioeconomic factors seem to explain most of these differences. One study estimated that the rate of asthma in children from families below the federal poverty threshold is higher (11.2%) than in families above it (6.7–8.5%). Low-income individuals with asthma experience symptoms more frequently, are hospitalized or are treated in the emergency room more often, and miss more days of school and work. In contrast to asthma, there is little evidence that food allergies are associated with income level. However, in those with food allergies, lower socioeconomic status is associated with worse outcome. A study by Dr. Ruchi Gupta found that very low income families with food allergies were likely to spend spend 2.5 times more on emergency care and hospitalizations than those at higher incomes.

Exposure to indoor and outdoor pollutants and other factors increasing risk of allergy and asthma

Some of the reasons individuals at lower incomes may have increased risk of asthma are increased exposure to indoor and outdoor pollutants (cigarette smoking, second-hand smoke exposure, nearby industrial pollutants, and highway traffic). In addition, substandard housing and poorly maintained homes increase exposure to cockroaches and molds, both of which are known factors that increase asthma. In contrast, food allergies have been associated with over-sanitization; however, there is no evidence that food allergy rates differ between different socioeconomic groups. It is hypothesized (termed the hygiene hypothesis) that decreased exposure in infancy and early childhood suppresses the natural development of the immune system and its ability to recognize harmless allergens from harmful ones.

However, in individuals with allergy or asthma, those at a lower economic status, are likely to have increased frequency and severity of symptoms. Some of the factors responsible for these increases include a lack of: transportation, access to medical care or allergy and asthma specialists who can accurately diagnosis their disease, education on disease management and understanding about the importance of regular care in preventing severe reactions. They may also be less likely to be able to take time off for medical appointments or afford preventative care or medications. Low-income families with food allergies may also be unable to afford allergen-free foods.

Clinical research unit at Sean N. Parker Center for Allergy and Asthma Research at Stanford University

The Center is committed to expanding allergy and asthma services to the underserved populations

Dr. Kari Nadeau is the Director of the Sean N. Parker Center for Allergy and Asthma Research at Stanford University. She is also the Chairman-elect of the Committee on the Underserved for the American Academy of Allergy, Asthma & Immunology and is passionate about providing access to allergy and asthma care to all. With feedback from underserved communities, the Committee continues to refine strategies to maximize access to allergy and asthma care in these communities.

Through generous contributions from those who share our vision, the Center has been able to initiate and implement a number of programs for the underserved. In particular, the Center is very thankful to the following individuals and organizations for their support.

  • Tim and Michele Barakett
  • Larry and Beth Gies
  • TripAdvisor Charitable Foundation and Global Giving

Tim and Michele Barakett have a daughter with peanut allergy and they understand the anxieties families with children with food allergies face. Even with extreme vigilance, Tim recalls a few occasions when his daughter accidentally consumed minute amounts of peanuts. Now, after his daughter has been desensitized to peanuts with immunotherapy at the Center, he and his family are now much less anxious knowing that she will not have an allergic reaction if she eats a few peanuts. Tim Barakett said, “We strongly support the work that Dr. Nadeau is doing and would like all families to have access to the kind of care we received. Immunotherapy has made a big difference to our lives and enabled us to lead normal lives without fear of an allergic reaction.”

Mr. and Mrs. Gies are also strongly supportive of Dr. Nadeau. In a statement of support, he said, “We passionately support Dr. Kari Nadeau and her team as we are committed to expanding our reach to underserved populations. We share Kari’s belief that all children should have the opportunity to live a full life, free from the anxiety that can be felt by living with food allergies.”

Dr. Chunrong Lin 

Some of the programs and services that we have been able to initiate and implemented through the generosity of our donors:

  • Dr. Chunrong Lin has been hired to serve the underprivileged populations in the Bay Area, Chicago and New York. The goal for the next 2 years is to expand our outreach to also serve New Orleans and Houston – two cities with large communities of underserved populations.
  • Dr. Lin will interact, engage, and educate over 100 allergists nationwide to use the state-of-the-art immunotherapy protocols that have been developed by Dr. Nadeau.
  • The Center has forged a partnership with Lucile Packard Children’s Hospital Stanford’s Teen Health Van. The Health Van, which recently celebrated its 20th anniversary, has long-standing partnerships with community organizations and schools that specifically serve low income youth. Through the Health Van, the Center was able to distribute epinephrine autoinjectors and educate and train low income youth with food allergies. 
  • The Center has treated more than 100 patients in the past year across the U.S. (Cincinnati, Chicago, New York City, Los Angeles, Seattle, and the San Francisco Bay Area) in pediatric clinical trials in food allergy and asthma who come from underserved/underprivileged communities.

Dr. Nadeau’s vision is to narrow the existing inequities that disproportionately affect underserved families nationally and globally.

The Center plans to expand its influence beyond the US borders, as there is a dire need for treating allergies and asthma in underserved populations in developing countries. Dr. Maryam Farzanegan, Clinical Associate Professor at the Global Medicine Program at the Keck School of Medicine applauds the Center’s efforts to impact the underserved populations in other states and other countries as such programs will support attainment of the Sustainable Development Goals, adopted by member states of the United Nations including the US. “Fulfillment of the highest attainable standard of health, as well as access to health care services, is a fundamental human right” she emphasized.

Providing quality health care for all individuals and families is both ethical and cost effective. The Sean N. Parker Center for Allergy and Asthma Research strives to make a global impact in the dire need to treat allergies and asthma in the underserved.

By Vanitha Sampath

Vanitha Sampath received her PhD in Nutrition from the University of California at Davis. At the Sean N. Parker Center for Allergy and Asthma Research, as a medical writer and content manager, she enjoys being in the midst of groundbreaking research in asthma and allergy and is committed to communicating the scientific advances of the Center and spreading awareness of its mission and vision. 

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