Black Detroit children with asthma hardest hit by seasonal allergies

by Jena Brooker (Bridge Detroit) and John Upton (Climate Central)

This story was produced through a collaboration between BridgeDetroit and Climate Central.

River, 3, plays on his iPad while using a nebulizer to treat his asthma. Detroit is a majority-Black city where children suffer from asthma and related complications at a rate three-quarters higher than the rest of the state. Credit: Quinn Banks, Special to BridgeDetroit

Trying to fall asleep at night, three-year-old River wheezes and coughs, unable to catch his breath. He calls for help, prompting another trip to the emergency room.

Like many Black children in Detroit growing up among high levels of fossil fuel and other types of industrial pollution, River suffers from breathing difficulties including asthma. His mom says the symptoms are worse during seasonal allergy peaks, when pollen pours down from tree branches and dusts up from grasses and other plants, triggering his asthma attacks.

“It’s the same time every year, these seasonal transitions,” said Terra Castro, River’s mom. Every day she vacuums, uses a humidifier and an air purifier, and keeps the windows shut. Still, she said, River’s breathing issues have “escalated.”

Detroit is a majority-Black city where children suffer from asthma and related complications at a rate three-quarters higher than the rest of the state – some of the worst asthma rates in the country, according to 2021 findings from the Michigan Department of Health and Human Services. The department concluded that a Black resident in Detroit was more than three times more likely than a white resident in the city to be hospitalized for asthma.

River, 3, and his mother, Terra Castro, on Thursday May 9, 2024, inside their home on Detroit’s east side. Credit: Quinn Banks, Special to BridgeDetroit

Seasonal allergies are a leading driver of asthma attacks. And it’s children that tend to suffer the worst of it.

“Asthma can happen at any point in your life, but asthma is mostly a childhood disease — it presents in childhood and it’s worse in childhood,” said Dr. Aishwarya Navalpakam, a Michigan native who treats and researches asthma and other allergic conditions at the Children’s Hospital of Michigan in Detroit.

“When you talk to doctors who take care of asthma you realize, especially for kids, it’s allergic asthma,” Navalpakam said.

Children suffering from asthma endure rafts of impacts that cumulatively drive down the overall quality of their lives — also affecting the lives of their families. They’re often afflicted by related conditions, including eczema and allergic reactions to certain foods.

“It has a huge impact on their general health,” Navalpakam added. “In terms of allergies, you have the chronic congestion. You’re coughing. You have post nasal drainage. You’re clearing your throat. You can’t sleep at night. You’re snoring.”

Seasonal allergy symptoms are worsening as heat-trapping pollution drives temperatures upward. Warmer springs and falls and rising levels of carbon pollution — which can serve as a fertilizer — are leading to more frequent and intensive pollen production.

In temperate climates like Michigan’s, seasonal allergies generally coincide with frost-free periods from the spring to the fall. In Detroit, a Climate Central analysis of weather station data shows the last spring freeze is occurring about 10 days earlier on average than was the case in 1970, while the first freeze of the fall is arriving about 19 days later on average.

Warmer temperatures, including those found in high-density urban environments with few trees but lots of concrete and blacktop, also reduce air quality by promoting chemical reactions that produce ozone pollution and by leading to stagnant air conditions. Poor air quality can be a driver of asthma and asthma attacks.

Climate Central modeling of urban temperatures based on the amount of greenery, concrete and other surfaces indicates temperatures in River’s neighborhood on the east side are elevated by about 8°F, compared with non-urban areas. In some other parts of Detroit, temperatures are elevated by as much as an estimated 11°F.

“Our allergy seasons are just getting bigger and bigger and earlier and earlier,” said Navalpakam, a member of the Michigan Clinicians for Climate Action, a coalition of Michigan health professionals focused on reducing health impacts from rising temperatures. “The seasons are lasting longer.”

Other barriers

During the past year, River has gone to the emergency room three times with breathing difficulties and once to urgent care. Each time he received a steroid to reduce inflammation and was sent home. In April, River developed pneumonia, a lung infection that can result from untreated allergies, and he was finally diagnosed with asthma.

Led by scientists from Detroit-based Henry Ford Health System, researchers examined the medical histories of hundreds of Detroit children whose health is being methodically tracked. They reported in 2020 that disparities detected between Black and white kids experiencing asthma, eczema and other allergies at age 2 persisted through their 10th birthdays.

Dr. Alan Baptist, a clinician and researcher who leads Henry Ford Health’s division of Allergy and Immunology, pointed to two main factors influencing the high allergy and asthma rates among Detroit’s Black children: Exposure to high levels of pollution in inner-city environments and financial and other barriers that prevent Black families from obtaining needed medical care. (Baptist was not an author of the group’s 2020 study.)

“Things like urban environments or inner city environments can often have significant deleterious effects on health and contribute to worsening of asthma and worsening of allergies,” Baptist said. “If a patient doesn’t have access to an allergy specialist, that can contribute to a worse outcome.”

The health disparities between Black children and other kids in Detroit are rooted in what Baptist described as structural racism and segregation. He said approaches for reducing these inequities have been topics of “entire textbooks.”

Baptist said healthcare providers need to understand the specific challenges facing their individual patients.

“Do they have transportation issues? Are they able to afford the medications you’re prescribing,” he said. “Thankfully, healthcare systems are doing a better job of identifying those factors and then involving, for example, social work where appropriate.”

Missing school due to asthma and allergies is a common experience for Detroit children.

River, 3, who lives on Detroit’s east side, has visited the emergency room three times and an urgent care once in the past year due to breathing issues. Credit: Quinn Banks, Special to BridgeDetroit

Students who are chronically absent in preschool, kindergarten, and first grade are less likely to read at grade level by third grade, making them four times more likely to drop out of high school compared to proficient readers, according to the United States Department of Education. Absenteeism negatively affects social and emotional development as well.

This year alone, Castro said River’s persistent cough “almost every day,” lethargy, and trouble breathing have caused him to miss a month of preschool. Soon, they plan to return to an allergist to get bloodwork done to see which allergens are causing River’s ailments.

With asthma, using a long-acting inhaler or oral medication is important for reducing the severity and impact. However, in Detroit, those on Medicaid, like River, rely on the emergency room to manage their asthma 50% more than their counterparts across the state, according to a Michigan Department of Health and Human Services report.

This year, Wayne County installed 100 stationary air monitors throughout the county, and plans to provide 500 mobile ones, including a number to attach to children’s inhalers to determine the air quality at times of asthma attacks. Using that data, county health officials hope to get information to the city’s most vulnerable residents to prevent future asthma attacks, and hold corporate polluters accountable.

Now, breathing treatments are a twice-daily routine for River.

Coaxed with his only allowed iPad-time of the day, River sits on a blanket on the couch to use his nebulizer, attempting multiple times to turn the machine off, or take the mask off.

“Keep it on please,” Castro has to gently remind River over the 5-minute period.