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Mahboobeh Mahdavinia, MD, says annual follow-up, not initial specialist access, is the missing piece in food allergy resolution disparities.
Closing the racial gap in food allergy resolution will require addressing follow-up frequency rather than initial specialist access, according to Mahboobeh Mahdavinia, MD, PhD, a board-certified allergist/immunologist from The University of Texas Health Science Center at Houston.
HCPLive spoke with Mahdavinia on the new FORWARD analysis, examining resolution rates in 1359 children with physician-diagnosed IgE-mediated food allergy. Resolution rates varied widely by food: about a third of milk (35%), soy, (32%) and wheat (27%) allergies resolved in children, compared to under 4% for peanut (3.8%) and shellfish (3.5%).1,2
Food allergy resolution occurred more frequently in White versus Black and Hispanic children. The study also revealed that food allergies were less likely to resolve in families with lower household income and parental health literacy scores and a higher area deprivation index.1
All 4 sites in the FORWARD registry are based in cities with established healthcare systems, and every enrolled child had been evaluated by an allergist at least once and carried insurance, most often Medicaid.¹ Mahdavinia said this ruled out a lack of specialist access as the primary driver of the resolution gap her team identified between White children and Black and Hispanic children.1 The deciding factor instead appeared to be how consistently families returned for the annual reevaluation needed to document resolution.
"There are a lot of other things around the social network of the child, not just the insurance or knowing the doctor, contributing to these factors,” Mahdavinia said.
Mahdavinia said resolving a food allergy typically requires repeat evaluation, often annually, to reassess IgE levels or pursue an oral food challenge. She pointed to broader social barriers, including difficulty making appointments and lacking a parent with the flexibility to manage a family calendar around specialist visits, as more likely explanations than insurance status alone.
Mahdavinia said she has observed the same pattern in her own clinic, where a subset of patients accumulates the most missed appointments despite having open access to be seen.
“Despite my busy clinics, I always [leave] spots open if my patients need to come at any time, and they're a group of patients that do not take that advantage of that,” she said. “It's a lot about the attitude around the care and maybe being more welcome that needs to be fixed.”
Mahdavinia said closing the gap will require systematic annual reevaluation built into food allergy programs, paired with proactive education and reminder outreach for families who miss appointments. She described her own clinic's practice of calling patients who miss a yearly visit to reinforce its importance but acknowledged many practices lack the staff to sustain that kind of outreach. Allergy is not a high-margin specialty, she said, making it difficult for private practices to add dedicated staff for follow-up outreach without broader systemic support.
Mahdavinia was clear the disparity does not stem from differential clinical decision-making. Asked whether socioeconomic or demographic factors influence how often a clinician schedules reevaluation or offers an oral food challenge, she said clinicians operate under the same ethical obligation to every patient regardless of background.
“We're not going to ever treat people differently, manage them differently, [or] give them appointments differently based on that,” she said.
Watch parts 1 and 2 here: Socioeconomic, Racial Disparities Linked to Food Allergy Resolution and Racial Gap in Food Allergy Resolution Traced to Access, Not Biology, respectively.
Editor’s note: Reported disclosures for Mahdavinia include Eli Lilly and Company, GENZYME CORPORATION, Blueprint Medicines Corporation, Regeneron Healthcare Solutions, AstraZeneca Pharmaceuticals LP, Takeda Pharmaceuticals U.S.A., Inc., Grifols USA, CSL Behring, Pharming Healthcare, Inc., Novartis Pharmaceuticals Corporation, and Paratek Pharmaceuticals.
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