ArticlePloS one2026
Language barriers in pediatric food allergy care: A single-center study on healthcare disparities.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThere is limited knowledge of healthcare utilization and food allergy outcomes among non-primary English-speaking patients in the United States, despite language barriers potentially being a risk factor for less optimal health outcomes.
methodsA retrospective cohort study was conducted of patients 0-18 years old with food allergy seen at our institution's allergy and immunology clinic between 1/1/2018-12/31/2021. Only patients with food allergy, defined as prior history of symptoms consistent with IgE-mediated reaction to food(s) and positive skin prick testing (wheal ≥ 3 mm) or food-specific IgE > 0.35, were included. Demographics and clinical data were obtained from the electronic health record (EHR). Regression analyses examined the association between patient/guardian-reported primary language and healthcare utilization, and whether COVID-19 pandemic modified these associations.
resultsOf the 1,418 patients with food allergy identified, 1,267 were primary English speakers and 151 were non-primary English speakers. Non-primary English-speaking patients had lower odds of EHR portal activation as compared to primary-English speakers (52.3% vs 81.8%, adjusted odds ratio = 0.43, 95% confidence interval (CI) 0.29-0.62). Regarding non-primary English-speakers, an increase in the probability of EHR portal activation (from 61.6% [95% CI 51.5% - 71.8%] to 70.0% [95% CI 60.8%-78.7%]) and food-related emergency department visits (from 3.7% [95% CI -0.4%-7.9%] to 19.4% [95% CI 10.7%-28.0%]) from the pre-COVID-19 to COVID-19 period was noted.
conclusionDisparities in rates of EHR portal activation and emergency department utilization which were differentially affected by the COVID-19 pandemic were identified among non-primary English-speaking patients in a cohort of pediatric patients with food allergy at a tertiary care referral center in the United States. This study highlights the need for greater understanding of language-based health disparities in food allergy and for more equitable EHR portal access among non-primary English-speaking patients.
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