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Structural racism involves the policies and practices that have been put in place over time through government and institutions. The physical and social environments where people of African, Latinx, and Indigenous heritage live reflect grave inequities that can influence the risk of developing allergic diseases, including asthma and atopic dermatitis. Physiologic stress responses caused by these inequities may contribute to worsened disease control.

In a feature review published in the Journal of Allergy and Clinical Immunology, researchers assessed the indirect and direct pathways by which structural racism may worsen the incidence and outcomes of asthma and atopic dermatitis in minority groups.

Data were pulled from several works to create a conceptual framework. Interpersonal racism may inhibit access to appropriate health care, while environmental factors such as disproportionate exposure to pollutants and environmental hazards in Black, Latinx, and Indigenous communities may contribute to higher morbidity from asthma and atopic dermatitis.

Upstream pathways such as redlining have led to unequal distributions in wealth and poor housing quality in Black and immigrant communities. Poor air quality in these communities, along with low socioeconomic position and mass incarceration, may contribute to inflammation and worsened asthma and atopic dermatitis. The researchers concluded that structural racism to this degree has embedded a physiologic stress response that may be responsible for increased risk of allergic conditions and worsened symptoms.

In closing, healthcare providers working in allergy and clinical immunology should be aware of these factors that may contribute to disease severity. In addition, more efforts should be made to increase the inclusion of Black, Latinx, and Indigenous groups in studies on the development of asthma and atopic dermatitis. Finally, the medical community should also actively participate in improving policies and advocating for structural changes in health care regarding ethnic and racial disparities [1].

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[1] Martinez, A., de la Rosa, R., Mujahid, M., & Thakur, N. (2021). Structural racism and its pathways to asthma and atopic dermatitis. Journal of Allergy and Clinical Immunology, 148(5), 1112–1120. https://doi.org/10.1016/j.jaci.2021.09.020