Association of Allergy Specialty Care and Asthma Outcomes for Medicaid-Enrolled Children

To assess the effectiveness of allergy specialty care on the reduction of asthma-related adverse events (AAEs) for patients enrolled in the Arkansas Medicaid program.This study evaluated Medicaid-enrolled (ME) children aged 5 to 18 years with a documented asthma diagnosis in 2018. Children with other significant pulmonary conditions were excluded. The final sample comprised 21 896 children. Prior to propensity score matching, 8.9% of the cohort experienced an AAE, 58% were male, and 58% were aged between 5 and 11 years. The racial and ethnic distribution of the unmatched sample was 39% white, 33% Black, and 6% Hispanic.This retrospective cohort study used the Arkansas All-Payers Claims Database to identify ME children who had a visit with an allergy specialist in 2018. Asthma was defined by the presence of at least 1 International Classification of Diseases, Tenth Revision diagnosis code J45.xx in 2019. Children who received allergy specialty care were propensity score matched to children with asthma who did not receive such care. Propensity score matching yielded 2964 matched pairs (total n = 5928). Multivariable logistic regression was used to evaluate the association between the receipt of allergy specialist care in 2018 and AAEs in 2019. AAEs were defined as any emergency department visit or inpatient hospitalization with a primary or secondary diagnosis of asthma (J45.xx) emergency department visit and/or inpatient hospitalization. Atopic comorbidities including allergic rhinitis, food allergy, and atopic dermatitis were also assessed.Prior to matching, a higher percentage of children evaluated by an allergy specialist had persistent asthma, were atopic, and received influenza vaccination. In the matched sample, 10.1% of patients experienced an AAE in 2019. Patients who received allergy specialty care experienced 21.0% lower odds of experiencing any AAE (adjusted odds ratio: 0.79; 95% CI: 0.63, 0.98) in the following year compared with propensity-matched patients who did not receive allergy specialty care (ME: 9.1% vs 11.0%; P = .04).Among Arkansas ME children with asthma, receipt of allergy specialty was associated with a significant reduction in asthma-related adverse events.This study builds on prior evidence demonstrating the benefits of subspecialty care for pediatric patients with asthma. The observed reduction in AAEs underscores the clinical value of timely referral to allergy specialists, particularly for children with persistent or difficult-to-control asthma. General pediatricians should recognize that allergy evaluation may not only improve symptom control but also reduce emergency visits and hospitalizations. These findings reinforce the importance of identifying at-risk patients early and advocating for equitable access to specialty care, especially within Medicaid populations.