Language Barriers May Influence Diagnosis of Allergies in Children


In addition to language barriers, pharmacy translation software errors may cause further complications when filling patient prescriptions.

A recent study shows that language difficulties may result in underdiagnosed allergic conditions such as food allergy, asthma, and eczema, in some children. Languages can pose barriers for patients who are trying to receive care and allergies and asthma are no different, according to the investigators. In addition, a new medically challenging case further showcases the possibility for pharmacy translation software to mistakenly interfere with the proper filling of prescriptions.

Child using an inhaler

Image credit: New Africa |

The retrospective study involved the review of electronic health records of all patients under 18 years of age who were seen in a primary care pediatric clinic from July 1, 2020, to April 30, 2023. Approximately 48.6% of the children were female, and the mean age was 6.2 years of age. The majority of children were Black (80.4%) and enrolled in Medicaid (78.9%), and 14.8% of participants preferred a language other than English (4% Haitian Creole, 4% Spanish, and 6.5% other).

“We wondered if those who spoke a language other than English would be underdiagnosed for some allergic conditions,” says Hao Tseng, MD, lead author on the study. “Among children with a language preference other than English, the diagnosis of asthma was less than half as common, eczema was about [two-thirds] as common, and allergic rhinitis was slightly more than half as common when compared with children whose preferred language was English. A similar correlation for the diagnosis of food allergy was deemed not statistically significant.”

An unrelated report demonstrated that a girl 7 years of age who spoke Spanish was diagnosed with a fish allergy and prescribed an epinephrine autoinjector. This required a school medication form, allowing the girl to have the autoinjector available at school. The prescription, which was translated into Spanish using a translation software, was sent to the pharmacy; however, there was a translation error resulting in the school not accepting the epinephrine autoinjector because the form did not match the prescription exactly. This resulted in the patient not receiving proper treatment for 4 months.

“Patients with limited English proficiency encounter unexpected barriers to care and remain a vulnerable patient population,” says Margaret Huntwork, MD, senior author of the paper. “The pharmacy translation software is not the only thing to blame for this case of a delay in securing a potentially life-saving medication in the school setting. Communication between the family, the physician, the school nurse, and the pharmacy is essential to ensure safety and success of students with allergies.”


ACAAI. Language barriers may cause some children to be underdiagnosed for allergic conditions. News release. November 9, 2023. Accessed November 13, 2023.

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