Home Health We need more research on asthma and allergies in Asian American children

We need more research on asthma and allergies in Asian American children

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We need more research on asthma and allergies in Asian American children

A few years ago, in our allergy clinic, we saw a 9-month-old Filipino boy whose skin was completely covered in eczema. Pus was oozing from raw, open sores where he scratched too much. He had already been diagnosed with an allergy to cashews and peanuts, and visited us after an emergency room visit for a reaction to hummus. It was difficult to console his parents. Even worse, patients like this child are becoming increasingly common.

Allergies are becoming increasingly common in the United States and around the world. One in thirteen children – 5.6 million – in the US have food allergies, resulting in more than 200,000 emergency department visits every year. Meanwhile, asthma rates have risen increased dramatically in the past forty years. It is common knowledge that black children do, compared to white children higher rates of eczema, food allergies, asthma and allergic rhinitis (hay fever), and Hispanics have higher rates of food allergies and asthma. But less is known on allergic diseases in Asian Americans.

This became personal when a young family member (Charles’ son) developed a soy allergy. In a Chinese-American household, it was difficult not to eat tofu or season stir-fries with soy sauce. Eventually he outgrew it. But then another young family member (Charles’ daughter) got hay fever. Every year her stuffy and runny nose heralds the beginning of spring. How many other Asian American parents across the country had the same pain — or, for all those kids with multiple food allergies like the ones we see in the clinic, probably much worse?

As allergists in the San Francisco Bay Area, we find that a large portion of our patients identify themselves as Asian American, the fastest growing racial group in the United States. The Asian American population – more than 22 million people – consists of more than two dozen ethnic subgroups, including Chinese, Indians, Koreans, Hmong, Bangladeshi and Mongolian. Yet there is a yawning lack of allergy data to guide our decision-making.

Determined to address this information vacuum, we, along with colleagues at Sutter Health and Stanford, reviewed electronic health record data from Sutter Health, a large multi-payer healthcare system in Northern California. Using non-Hispanic white children as a reference, we looked at rates of eczema, food allergy, asthma and allergic rhinitis – four of the most common allergic conditions – in nearly 500,000 children, focusing on Asian American children overall. as Asian American subgroups.

Building on previous researchwe found that Vietnamese and Filipino children had significantly increased odds of all four allergic diseases, as well as compared to other Asian American subgroups. For example, Filipinos were almost twice as likely to develop allergic rhinitis and asthma as white children, almost four times as likely to develop eczema, and almost five times as likely to develop food allergies. Note that multiethnic Asians – Asian Americans with one Asian and one non-Asian parent – ​​were also more likely to develop all four conditions.

Furthermore, East Asian children – Korean, Japanese and Chinese – had an increased risk of eczema and food allergy, but surprisingly a lower risk of asthma. The underlying factors contributing to the generally higher prevalence of allergic diseases among Asian American children, especially among Vietnamese and Filipinos, are unclear but may be related to social factors such as immigration patterns, diet, and acculturation status. By studying differences between diverse Asian populations, we can learn about new genetic pathways for these diseases, as Asians currently only 10% of the world’s genetic databasesdespite having 60% of the world population.

The bottom line is that the Asian American population, especially when broken down into ethnic groups, has allergy health outcomes that are different from each other and quite different from those of other ethnicities. Each ethnic group has unique cultural and social characteristics. Furthermore, enormous income differences among Asian American ethnic groups likely mask meaningful health disparities among these groups. Placing all of these groups under the same umbrella, while useful for political purposes, overlooks the diversity within the Asian American population. For Vietnamese, Filipino and multi-ethnic Asian children in particular, rates of allergic disease are unexpectedly high, so much so that for some conditions they are higher than the rates seen in black children. This is particularly useful information for pediatricians, emergency physicians, and general practitioners, who are often the first point of contact for evaluating children with allergic conditions.

In a broader context, the unfolding story of allergy disparities within Asian American subgroups is playing out in other areas of medicine. When these Asian American groups are broken down, Korean adults are more likely have gastrointestinal cancers; Asian Indian adults are more likely death from cardiovascular disease and stroke; and Japanese women are too more likely to die from pancreatic cancer. That’s expected to include the Asian American population more than 46 million in 2060that make up more than 10% of the projected U.S. population, more research is needed. However, only between 1992 and 2018 0.17% of the National Institute of Health’s budget was spent studying Asian American health. Clearly, much more funding is needed to study allergies and other diseases that affect this population.

Over the course of a few months, we treated the Filipino boy’s eczema with topical steroids, aggressive moisturizing, and wet wipes, which completely cleared his skin. When he turned 2, he underwent surgery oral immunotherapyand we were able to desensitize him to the foods he was allergic to, giving his parents more peace of mind. We still don’t know exactly why he is more likely to have allergies compared to other Asian American children, but we hope to figure out the reasons in the coming years. Our research findings highlight not only an issue of medical importance, but also an issue of healthcare equity affecting hundreds of thousands of Asian American children.

Charles Feng, MD, is an allergist/immunologist in the San Francisco Bay Area. Latha Palaniappan, MD, is a professor of medicine at Stanford University School of Medicine. Anna Chen Arroyo, MD, MPH, is a clinical associate professor of medicine at Stanford University School of Medicine.

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