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Author Notes:

Anne M. Fitzpatrick, Ph.D., 2015 Uppergate Drive, Atlanta, Georgia 30322, Telephone: 404-727-9112, Facsimile: 404-712-0920, anne.fitzpatrick@emory.edu

Dr. Shih reports service on advisory boards for Teva and AstraZeneca, outside the submitted work.

Subjects:

Research Funding:

This study was supported in part by R01NR013700, R01NR012021, R01HL69170, UL1TR000454, and the Children’s Healthcare of Atlanta Pediatric Research Alliance Center for Clinical Outcomes Research and Public Health

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Allergy
  • Immunology
  • Asthma control
  • Asthma exacerbation
  • Biomarker
  • Eosinophil
  • Type 2 inflammation
  • Allergic sensitization
  • BLOOD EOSINOPHIL COUNT
  • NITRIC-OXIDE LEVELS
  • SEVERE UNCONTROLLED ASTHMA
  • 1ST 6 YEARS
  • FUTURE ASTHMA
  • HEALTH-CARE
  • OUTCOMES
  • MEPOLIZUMAB
  • INDICATORS
  • PHENOTYPES

Exploring the Utility of Noninvasive Type 2 Inflammatory Markers for Prediction of Severe Asthma Exacerbations in Children and Adolescents

Tools:

Journal Title:

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE

Volume:

Volume 7, Number 8

Publisher:

, Pages 2624-+

Type of Work:

Article | Post-print: After Peer Review

Abstract:

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.

Copyright information:

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/).
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