A Roadmap for Mitigating Disparities in Pediatric Allergy and Asthma Care

New UH Rainbow Division Chief is national leader on the crucial topic

Innovations in Pediatrics | Summer 2021

Stark disparities in prevalence and outcomes among different groups of patients suffering from allergy, asthma and immunological disorders require a re-doubled effort on the part of the profession to address and mitigate inequities. That’s the view of Princess Ogbogu, MD, new Division Chief of Pediatric Allergy and Immunology at UH Rainbow Babies & Children’s Hospital.

Princess Ogbogu, MD

“Blacks and Puerto Ricans are two to three times more likely to be hospitalized and to die from asthma compared with non-Hispanic whites,” Dr. Ogbogu says. “Although not well studied, particularly in adults, atopic dermatitis, food allergy, and allergic rhinitis all appear to be more common in Black than in white persons. It's primarily because of the nature of the specialty that we see the disparity so glaringly. This is an area that, as a specialty, we can make a really big impact. As an institution, we can also make a huge impact, especially because of the patient population that we serve at UH Rainbow.”

Dr. Ogbogu has been working on these issues for some time in her capacity as chair of a working group on the underserved within the American Academy of Allergy, Asthma and Immunology. That group recently published a report detailing its recommendations for best practices in addressing disparities and inequities. They include:

• Addressing social determinants of health and adopting policies to improve access to specialty care and treatment for the underserved through telemedicine and community partnerships
• Cross-cultural provider training to reduce implicit bias
• Greater inclusion of underserved patients in research
• Implementation of culturally competent patient education
• Recruitment and training of healthcare providers from underserved communities

Dr. Ogbogu and colleagues from Ohio State University and the University of Pennsylvania have also published separately on this topic, with recommendations published in the Journal of Allergy and Clinical Immunology Practice.

“We propose a four-prong approach to address inequities,” Dr. Ogbogu says. “It requires racial and ethnic inclusivity in research with respect to both participants and investigators, diversity in all aspects of training and practice, improvement in communication between clinicians and patients, and awareness of the social determinants of health. By communication we mean sensitivity to the role of language, cultural background, and health beliefs in physician-patient interactions and provision of training and equipment so that the use of telecommunication can be a resource for all patients.”

Beyond these recommendations, Dr. Ogbogu says, it will take extra effort on the part of allergy, asthma and immunology providers to make sure the actions they recommend for their patients can realistically be achieved.

“We make recommendations, but if patients live in environments where they can’t avoid cockroaches or mold or other things that could affect their asthma, then it's really difficult,” she says. “What we’re trying to do at UH Rainbow is work in a more holistic fashion and make sure that we're helping to at least be part of the solution and providing some of the tools so that the patients can bettertake care of themselves. We can all partner together. I think that gets lost in medicine sometimes. You make these recommendations, but they can't happen because they’re not rooted in somebody's lived experience in their real life. We need to understand what the problem is, look at the environment and the situation as a whole, and find out where we as providers and we as an institution can make impact that will help make people's lives better. We have a long way to go in doing that, but even asking the question starts the conversation and gets us going in the right direction.”

One solution she is implementing to make navigating allergy, asthma and immunology care easier for UH Rainbow patients, Dr. Ogbogu says , is locating a new specialty clinic in the UH Rainbow Babies & Children’s Ahuja Center for Women and Children, located in Cleveland’s Midtown neighborhood. The state-of-the-art women and children's health center offers pediatric primary care,  women’s health and OB/GYN services, pregnancy and parenting classes, community resources and much more – all housed in one convenient facility.

“We're the only specialty in there,” she says. “The primary care providers are finding it helpful to have us there because these are such common issues that the kids have, so it’s helpful having someone right there who can share expertise. We're hoping to continue to partner there and hope to have some more solutions that are multifaceted.”

For more information about Dr. Ogbogu’s work on disparities and inequities in pediatric allergy, asthma and immunology or for more information about the UH Rainbow Babies & Children’s Ahuja Center for Women and Children, please email Peds.Innovations@UHhospitals.org.

Contributing Expert:

Princess Ogbogu, MD
Division Chief, Pediatric Allergy and Immunology
UH Rainbow Babies & Children's Hospital
Clinical Associate Professor
Case Western Reserve University School of Medicine