Abstract
Hospitalization for asthma exacerbation is significantly related to overall poor asthma control. The study aimed to contrast post-hospitalization outcomes of those asthmatics who underwent serologic specific IgE (sIgE) testing for regional environmental allergens to an untested cohort. Of 8061 asthma encounters, 273 subjects who met the criteria were included in this retrospective cohort study. Those asthmatics identified with persistent disease were hospitalized at Miller Children’s Hospital during the period June 2008–October 2015. A total of 207 patients underwent sIgE testing during initial hospitalization for asthma and 66 were not tested. The Cox regression analysis assessed time from discharge to first emergency room (ER) visit, required systemic steroids, and next hospitalization in sIgE vs. non-tested groups, stratified by severity (mild or moderate-severe) and adjusted for age (≥ 12 or < 12), gender, and race. Serum allergy evaluation by sIgE testing reduced the hazard of an ER visit and systemic corticosteroids requirement by half in mild asthmatics (p < 0.05). The average time to next ER visit was almost 1 year in the allergy-tested group compared to < 6 months in the no-test group. Blood-based allergy evaluation as part of inpatient asthma treatment was shown to improve disease management specifically in time to next ER and/or exacerbation and systemic corticosteroids requirement in patients with mild disease. In more severe adolescent asthmatics, sIgE testing appeared protective against future hospitalization. Inpatient serologic testing may be beneficial in raising alertness in the asthma population, deploying early comprehensive care and lowering the rate of hospitalization.
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Financial support for this research activity includes MemorialCare Health System/Miller Children’s Hospital and The Translational Pulmonary and Immunology Research Center (TPIRC) of Long Beach, CA.
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Dr. Brock and Dr. Randhawa donated substantial contributions to the conception and design of the work, in addition to all other aspects of authorship as below. Other listed authors contributed to the acquisition, analysis, or interpretation of data for the work, drafting the work, and revising it critically for important intellectual content, final approval of the version to be published and are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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At a Glance Commentary: To date, no study has analyzed the efficacy of blood-based allergy evaluation (serologic sIgE testing) as part of inpatient asthma management to determine post-hospitalization asthma treatment and clinical outcomes. The goal of this study is to compare post-hospitalization outcomes of asthmatics who underwent objective allergy and lung function testing during initial hospitalization to a cohort which did not.
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Brock, J.P., Nussbaum, E., Morphew, T.L. et al. Allergy Evaluation During Hospitalized Asthma Improves Disease Management Outcomes. SN Compr. Clin. Med. 1, 328–333 (2019). https://doi.org/10.1007/s42399-019-0044-9
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DOI: https://doi.org/10.1007/s42399-019-0044-9