Background: Noninvasive markers of type 2 inflammation are needed to identify children and adolescents who might benefit from personalized biologic therapy. Objective: We hypothesized that blood eosinophil counts would predict 1 or more acute visits for asthma and that prediction could be improved with the addition of a second, noninvasive type 2 inflammatory biomarker. Methods: Children and adolescents 5 to 21 years (N = 589) with an asthma exacerbation necessitating systemic corticosteroid treatment in the previous year completed a characterization visit and telephone calls at 6 and 12 months. The primary outcome was an acute visit for asthma with receipt of systemic corticosteroids. Acute visits were verified by medical record review. Exploratory outcomes included time to first acute visit and hospitalization. Results: Acute visits occurred in 106 (35.5%) children and 72 (24.8%) adolescents. Elevated blood eosinophils were associated with increased odds and shorter time to first acute visit, but optimal cut-points differed by age (≥150 vs ≥300 cells/μL for children vs adolescents, respectively). The addition of a second marker of type 2 inflammation did not improve prediction in children, but increased the odds and hazard of an acute visit up to 16.2% and 11.9%, respectively, in adolescents. Similar trends were noted for hospitalizations. Conclusions: Blood eosinophils and other noninvasive markers of type 2 inflammation may be useful in the clinical assessment of children and adolescents with asthma. However, features of type 2 inflammation vary by age. Whether children and adolescents also respond differently to management of type 2 inflammation is unclear and warrants further evaluation.

Bordetella bronchiseptica infection is a common cause of pneumonia in animals but rarely causes disease in humans. Additionally, coinfection with Pneumocystis jirovecii is very uncommon and is occasionally seen in patients with acquired immunodeficiency syndrome (AIDS). We report a case of a 61-year-old HIV-negative man, who presented with hypoxic respiratory failure 2 days after completion of systemic intravenous antibiotic treatment for B bronchiseptica. His past medical history was significant for a benign thymoma. The patient was found to be coinfected with B bronchiseptica and P jirovecii. Laboratory results showed panhypogammaglobulinemia and low absolute B- and CD4 T-cells. Therefore, the patient was diagnosed with Good's syndrome. However, despite treatment with intravenous antibiotics and intravenous immunoglobulin, the patient continued to deteriorate and expired. This patient demonstrates the importance of recognizing this rare immunodeficiency early in order to improve morbidity and mortality. Furthermore, this case highlights the importance of early immunoglobulin screening in the presence of asymptomatic thymoma.

Telemedicine adoption has rapidly accelerated since the onset of the COVID-19 pandemic. Telemedicine provides increased access to medical care and helps to mitigate risk by conserving personal protective equipment and providing for social/physical distancing to continue to treat patients with a variety of allergic and immunologic conditions. During this time, many allergy and immunology clinicians have needed to adopt telemedicine expeditiously in their practices while studying the complex and variable issues surrounding its regulation and reimbursement. Some concerns have been temporarily alleviated since March 2020 to aid with patient care in the setting of COVID-19. Other changes are ongoing at the time of this publication. Members of the Telemedicine Work Group in the American Academy of Allergy, Asthma & Immunology (AAAAI) completed a telemedicine literature review of online and Pub Med resources through May 9, 2020, to detail Pre-COVID-19 telemedicine knowledge and outline up-to-date telemedicine material. This work group report was developed to provide guidance to allergy/immunology clinicians as they navigate the swiftly evolving telemedicine landscape.

The type 2 high endotype of asthma with adult onset is often characterized by severe, persistent, steroid-refractory eosinophilic inflammation. Interleukin 5 (IL-5) is a pivotal cytokine for eosinophil survival. The amelioration of eosinophilic inflammation through anti—IL-5 therapies (mepolizumab, reslizumab, and ben-ralizumab) reduces exacerbations and improves control is and well tolerated overall.

The COVID-19 pandemic created an explosion in the use of telehealth. However, telehealth consists of much more than a video discussion between doctor and patient. Since the onset of the COVID-19 pandemic, allergists have demonstrated a high level of synchronous telemedicine adoption with existing patients but have not taken full advantage of other virtual care modalities that have the potential to facilitate the efficient delivery of allergy care to the broader population. This is partially due to a lack of awareness about the various remote care services and how to implement and bill for them appropriately. This rostrum describes the spectrum of telehealth services, reviews existing literature on the use of telehealth in allergy, and provides suggestions about how allergists and immunologists can optimize the use of telehealth to optimize patient access and outcomes as well as receive appropriate compensation for specialty clinical services provided by themselves and their staff.

Addressing coronavirus disease 2019 (COVID-19) vaccine hesitancy and minimizing potential vaccine contraindications are critical to combatting the pandemic. We describe a practical approach to immediate adverse events after the first dose of messenger RNA vaccines for severe acute respiratory syndrome coronavirus 2, focusing on diagnosis and management of allergic reactions.

Waqar and Agarwal1 make significant points regarding the rapid adoption of technology, specifically telemedicine, into fellowship programs. As all of the authors in the American Academy of Allergy, Asthma & Immunology telemedicine work group will attest to, many factors need to be taken into account before adopting a functional telemedicine platform in the clinic. Keeping up with current regulations to maintain compliance in light of the changes during the COVID-19 pandemic and beyond also requires considerable effort.2 What is uniquely addressed in this letter are the practical issues that allergists and immunologists face with telemedicine. Although spirometry is limited at this time, technologies are being created and implemented to accomplish home forced expiratory volume in 1 second measurement.3 Assessing and teaching the inhaler and emergency epinephrine device technique can be performed remotely and re-evaluated at follow-up visits via telemedicine. Telemedicine has also been valuable to evaluate and monitor our most at-risk patients, such as those with immunodeficiency, as they may be fearful of returning to the clinic for routine in-person evaluations. Time will reveal more data in our field as we are able to obtain cost-benefit analysis for allergy and immunology telemedicine encounters. By providing innovative, valuable, and cost-effective care while educating our fellows and continuing to rapidly adapt in times of need, we will persist in pushing open the door of modern medical technology in health care.

Objective: To provide an overview of the literature on respiratory infectious disease epidemic prediction, preparedness, and response (including pharmaceutical and nonpharmaceutical interventions) and their impact on public health, with a focus on respiratory conditions such as asthma. Data Sources: Published literature obtained through PubMed database searches. Study Selections: Studies relevant to infectious epidemics, asthma, modeling approaches, health care access, and data analytics related to intervention strategies. Results: Prediction, prevention, and response strategies for infectious disease epidemics use extensive data sources and analytics, addressing many areas including testing and early diagnosis, identifying populations at risk of severe outcomes such as hospitalizations or deaths, monitoring and understanding transmission and spread patterns by age group, social interactions geographically and over time, evaluating the effectiveness of pharmaceutical and nonpharmaceutical interventions, and understanding prioritization of and access to treatment or preventive measures (eg, vaccination, masks), given limited resources and system constraints. Conclusion: Previous epidemics and pandemics have revealed the importance of effective preparedness and response. Further research and implementation need to be performed to emphasize timely and actionable strategies, including for populations with particular health conditions (eg, chronic respiratory diseases) at risk for severe outcomes.

The adoption of telemedicine services by the allergist community was minimal before the severe acute respiratory syndrome coronavirus 2 pandemic, but has gained dramatic momentum in recent months. We present the results of a survey study aimed at measuring patient satisfaction with a cloud-based telemedicine platform and performed at an academic allergy clinic during the pandemic.