The journal of allergy and clinical immunology. Global最新文献

{"title":"Clinical remission of mild-to-moderate asthma: Rates, contributing factors, and stability","authors":"Mana Ishizuka MD,&nbsp;Naoya Sugimoto MD, PhD,&nbsp;Konomi Kobayashi MD,&nbsp;Yuri Takeshita MD, PhD,&nbsp;Sahoko Imoto MD, PhD,&nbsp;Yuta Koizumi MD, PhD,&nbsp;Yusuke Togashi MD,&nbsp;Yutaro Tanaka MD,&nbsp;Maki Nagata MD,&nbsp;Saya Hattori MD,&nbsp;Yuki Uehara MD,&nbsp;Yuki Suzuki MD, PhD,&nbsp;Hikaru Toyota MD, PhD,&nbsp;Satoru Ishii MD, PhD,&nbsp;Hiroyuki Nagase MD, PhD","doi":"10.1016/j.jacig.2025.100431","DOIUrl":"10.1016/j.jacig.2025.100431","url":null,"abstract":"<div><h3>Background</h3><div>Although clinical remission (CR) of severe asthma has been extensively investigated, CR of mild-to-moderate asthma remains unexplored.</div></div><div><h3>Objective</h3><div>This study aimed to determine CR rates, contributing factors, and stability in patients with mild-to-moderate asthma.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 263 patients with asthma. Three-component CR was defined as no exacerbation, no daily oral corticosteroid receipt, and an Asthma Control Test score equivalent to that of the well control; 4-component CR included these parameters plus forced expiratory volume in 1 second of ≥80% predicted. CR during the 1 year and stability of CR over 10 years were retrospectively analyzed in patients with mild-to-moderate and severe asthma.</div></div><div><h3>Results</h3><div>The CR rates were significantly higher (4-component, 73.2%; 3-component, 81.0%) in patients with mild-to-moderate asthma compared with the CR rate in patients with severe asthma (4-component, 33.9%; and 3-component, 30.6%). A lower smoking index contributed to 3- and 4-component CR. Lower body mass index contributed to 3-component remission, and later onset and shorter asthma duration contributed to 4-component remission. In patients experiencing 4-component remission 10 years before, 80.3% maintained disease in remission; 89.1% of patients experiencing 3-component remission maintained disease in remission. In patients with disease that did not maintain 4-component CR after 10 years, predicted forced expiratory volume decreased, but no differences in inhaled corticosteroid and long-acting β-agonists/long-acting muscarinic antagonists receipt were detected between 10 years ago and the present. The current muscarinic antagonist receipt remained low, at 16.7%.</div></div><div><h3>Conclusion</h3><div>CR, including normalized forced expiratory volume, is obtainable and sustainable in most Japanese patients with mild-to-moderate asthma. Assessing CR in these patients may help avoid undertreatment and reduce future risks.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100431"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicenter food protein–induced enterocolitis syndrome (FPIES) data collection: Leveraging a REDCap FPIES registry for improved clinical outcomes","authors":"Ankona Banerjee MSc ,&nbsp;J. Andrew Bird MD ,&nbsp;Amy M. Scurlock MD ,&nbsp;Pooja Varshney MD ,&nbsp;Elizabeth Brunner MD ,&nbsp;Ankur Bhagwath BSc ,&nbsp;Benjamin Daines MD ,&nbsp;Malika Gupta MD ,&nbsp;Tevon Hood DO ,&nbsp;Maria Lee MD ,&nbsp;Michelle Lee BScA ,&nbsp;Emily Seminara BA ,&nbsp;Rachel Smith RN ,&nbsp;Gail Tan MD ,&nbsp;Marion Jose Valladares MD ,&nbsp;Hiral Waghela MD ,&nbsp;Duc T. Nguyen MD, PhD ,&nbsp;Sara Anvari MD, MSc","doi":"10.1016/j.jacig.2025.100434","DOIUrl":"10.1016/j.jacig.2025.100434","url":null,"abstract":"<div><h3>Background</h3><div>Food protein–induced enterocolitis syndrome (FPIES) is a non–IgE-mediated food allergy typically presenting in infancy but has also been recognized in adults. FPIES is an allergic emergency due to severe vomiting occurring 1 to 4 hours after ingesting the causative food protein. Since the 2017 FPIES guidelines, no prospective data exist on the prevalence, incidence, and clinical characteristics of FPIES.</div></div><div><h3>Objective</h3><div>We established a multicenter FPIES registry to systematically collect clinical data and biospecimens on FPIES patients.</div></div><div><h3>Methods</h3><div>The FPIES registry is a US multicenter REDCap database collecting epidemiologic data to support the evolving FPIES landscape in relation to age at diagnosis, triggers and coreactivity, disease resolution, and risk of disease conversion to IgE allergy. Questionnaire and biosampling strategies have been developed using a systems biology approach to identify determinants of FPIES.</div></div><div><h3>Results</h3><div>The registry includes patients with physician diagnosis of FPIES (ICD-10 code K52.21) from January 2015. Longitudinal REDCap instruments for FPIES data collection include: age at first reaction, age at diagnosis, reaction timing, symptoms, treatment, medical care or hospitalization for reaction, dietary triggers, atopic comorbidities, family history of atopy and FPIES, oral food challenge procedures (eg, intravenous line placement, dosing protocol, observation period, reaction timing, symptoms and treatment), age at food trigger resolution, food-trigger IgE, cases converting from atypical FPIES to IgE-mediated food allergy, and sample collection data.</div></div><div><h3>Conclusions</h3><div>The registry will provide a multicenter repository of data and biospecimens, enabling identification of clinical determinants and phenotypes of FPIES, better understanding of conversion risks, and identification of biomarkers and mechanisms associated with FPIES.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100434"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CCR3 deficiency shifts adaptive to innate-driven immunity in asthma","authors":"Susanne Krammer RPh ,&nbsp;Zuqin Yang PhD ,&nbsp;Hannah Mitländer MD ,&nbsp;Janina C. Grund MD ,&nbsp;Carol I. Geppert MD ,&nbsp;Ralf J. Rieker MD ,&nbsp;Sabine Zirlik MD ,&nbsp;Susetta Finotto PhD","doi":"10.1016/j.jacig.2025.100430","DOIUrl":"10.1016/j.jacig.2025.100430","url":null,"abstract":"<div><h3>Background</h3><div>Because of repeated contact with airborne allergens, patients suffering from allergic asthma experience acute asthma attacks, characterized by shortness of breath, chest tightness, and coughing. The underlying immune response is highly complex and involves various immune cells. Chemokines play a pivotal role in the appropriate relocation of these diverse immune cells, ensuring their directed migration to the site of inflammation, their survival, and their effector functions. In the context of allergic asthma, the chemokine receptor CCR3 is crucially involved in T_H2-mediated airway inflammation by recruiting eosinophils and other immune cells to the site of inflammation. However, more recent studies demonstrate its presence also on mast cells, macrophages, T cells, and dendritic cells.</div></div><div><h3>Objective</h3><div>We sought to investigate the role of CCR3 in different immune cell types during asthma pathogenesis.</div></div><div><h3>Methods</h3><div>Human peripheral blood cells collected from healthy controls and asthmatic individuals were analyzed for CCR3 expression. A murine model of asthma was used to compare wild-type and CCR3-deficient mice in the context of airway inflammation.</div></div><div><h3>Results</h3><div>In a human cohort of asthmatic patients, CCR3 mRNA expression was found induced in PBMCs and positively correlated with decreased lung function and blood eosinophilia. In a murine model of disease, CCR3 was found to be important for the establishment of eosinophilic inflammation. Moreover, CCR3-deficient mice showed impaired cytokine release, resulting in an innate-like mast cell and neutrophil-mediated lung inflammation and reduced T_H2-orchestrated eosinophil-driven asthma. In the absence of CCR3, CD8 T cells underwent phenotypic changes, inhibiting the development of migratory effector memory CD8 T-cell subsets.</div></div><div><h3>Conclusions</h3><div>Taken together, this work demonstrates the functional involvement of CCR3 in both innate and adaptive immune cells in the lung during asthma pathogenesis.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100430"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Randomized trial of ultraviolet irradiation units installed in homes of children and adolescents with asthma","authors":"Jonathan A. Bernstein MD ,&nbsp;Anand Seth PhD ,&nbsp;Marepalli Rao PhD ,&nbsp;Janyce C. Katz JD ,&nbsp;Umesh Singh MD, PhD ,&nbsp;William Greisner MD ,&nbsp;Michelle Lierl MD ,&nbsp;Benjamin Prince MD ,&nbsp;Kunjana Mavunda MD, MPH ,&nbsp;Cheryl K. Bernstein RN, BS, CRCC ,&nbsp;Tianyuan Guan PhD ,&nbsp;Amy J. Nation DO ,&nbsp;Amanda K. Rudman Spergel MD ,&nbsp;Alkis Togias MD ,&nbsp;Mark Glazman PhD","doi":"10.1016/j.jacig.2025.100427","DOIUrl":"10.1016/j.jacig.2025.100427","url":null,"abstract":"<div><h3>Background</h3><div>Asthma management involves medications with environmental control, but patient adherence to the latter is poor. A previous pilot study found an ultraviolet indoor air-irradiation system (CREON2000A) was effective in reducing asthma severity in children with mild to moderate asthma.</div></div><div><h3>Objective</h3><div>This trial’s purpose was to confirm these results in a larger population over a longer time duration.</div></div><div><h3>Methods</h3><div>A 12-month randomized, sham device–controlled multicenter study enrolled 79 children with mild to moderate persistent asthma aged 6 to &lt;18 years. Participants were randomized to have a CREON2000A ultraviolet air irradiation device or a sham device installed in their home’s ventilation system. Enrolled children were assessed with the Composite Asthma Severity Index at baseline and every 4 months; asthma treatment was adjusted according to National Heart, Lung, and Blood Institute EPR-3 guidelines. The primary analysis compared the efficacy of the CREON2000A versus sham device from baseline to end of study (12-month visit). A sensitivity analysis compared efficacy across the 4-, 8-, and 12-month visits.</div></div><div><h3>Trial registration</h3><div>Investigate the Effect of the CREON2000A on Asthma Control in Children With Mild to Moderate Persistent Asthma (CREON2000A), <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span>, NCT02715375.</div></div><div><h3>Results</h3><div>Baseline demographic characteristics of CREON2000A (n = 40) versus sham device (n = 39) groups were similar. The primary analysis estimated a difference in Composite Asthma Severity Index score for CREON2000A at 12 months relative to the sham device, which was not statistically significant (Δ_Estimated = 0.53; <em>P</em> = .404; 95% confidence interval, −0.576, 1.628). A sensitivity analysis detected a device benefit across all postbaseline values (Δ_Estimated = 0.76; <em>P</em> = .034; 95% confidence interval, 0.057, 1.465). A benefit was also observed for asthma daytime symptom score, average asthma exacerbations score, missed school days, rhinitis symptoms, and average number of respiratory infections (nominal <em>P</em> &lt; .05 in all cases).</div></div><div><h3>Conclusion</h3><div>This small trial is inconclusive, but some results show promise, suggesting that this device and the concept of indoor air irradiation as an environmental intervention is worthy of further study in children with mild to moderate persistent asthma.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100427"},"PeriodicalIF":0.0,"publicationDate":"2025-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143488850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-cell immunopathology of recurrent acute generalized exanthematous pustulosis associated with vancomycin","authors":"Eric M. Mukherjee MD, PhD ,&nbsp;Andrew Gibson PhD ,&nbsp;Matthew S. Krantz MD ,&nbsp;Rama Gangula MS ,&nbsp;Amy M. Palubinsky PhD ,&nbsp;Alan S. Boyd MD ,&nbsp;Jeffrey P. Zwerner MD, PhD ,&nbsp;Anna K. Dewan MD, MS ,&nbsp;Nontaya Nakkam PhD ,&nbsp;Katherine C. Konvinse MD, PhD ,&nbsp;Yueran Li PhD ,&nbsp;Ramesh Ram PhD ,&nbsp;Abha Chopra PhD ,&nbsp;Elizabeth J. Phillips MD","doi":"10.1016/j.jacig.2025.100426","DOIUrl":"10.1016/j.jacig.2025.100426","url":null,"abstract":"<div><h3>Background</h3><div>Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction to medication that presents within 72 hours of exposure with erythematous papules and plaques with overlying pustules. The immunopathogenesis and predisposing factors of AGEP are not well characterized.</div></div><div><h3>Objective</h3><div>To better understand the genetic risk factors and single-cell immunopathogenesis of AGEP, we longitudinally characterized a patient with recurrent AGEP after an initial episode triggered by vancomycin.</div></div><div><h3>Methods</h3><div>A clinical timeline over an 8-year period was paired with skin testing, histopathology, and immunogenetic and other testing at 3 time points. Skin biopsies performed on affected skin (positive vancomycin-delayed intradermal testing [IDT]) and unaffected control skin 8 years after the initial event were subjected to single-cell sequencing to measure gene and protein expression.</div></div><div><h3>Results</h3><div>The patient was HLA-A∗32:01 positive, which has been associated with vancomycin-induced drug reaction with eosinophilia and systemic symptoms. IDT remained positive over time, despite recurrent reactions without drug exposure. Clinical features and histopathology of IDT-positive skin were consistent with AGEP. Single-cell analysis of affected skin showed polyclonal T_H17-like cells with gene expression signatures similar to T-cell response during prevalent infectious diseases.</div></div><div><h3>Conclusions</h3><div>This patient exhibited persistent vancomycin-positive IDT despite distinct nondrug episodes of ALEP/AGEP. This suggests that AGEP may be triggered by both antigen-specific and non–antigen-specific factors. AGEP-affected skin showed an inflammatory infiltrate with a T_H17-like effector population, which may represent potentially actionable targets for therapeutic intervention. The presence of HLA-A∗32:01, a defined risk factor for vancomycin-induced drug reaction with eosinophilia and systemic symptoms, may indicate a shared predisposition, warranting further study.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100426"},"PeriodicalIF":0.0,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143332866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National best practice guidelines for anaphylaxis prevention and management in Australian schools","authors":"Merryn J. Netting PhD ,&nbsp;Briony Tyquin MNurs ,&nbsp;Wendy Freeman MBBS ,&nbsp;Katie Frith MBBS ,&nbsp;Heather Roberts BHlthSc Hons ,&nbsp;Maria Said RN ,&nbsp;Preeti Joshi PhD ,&nbsp;Sandra Vale PhD","doi":"10.1016/j.jacig.2025.100413","DOIUrl":"10.1016/j.jacig.2025.100413","url":null,"abstract":"<div><h3>Background</h3><div>Anaphylaxis prevention and management in the school setting is an important health and safety issue as the rates of food allergy in children continue to increase.</div></div><div><h3>Objective</h3><div>We describe the development and review of the Australian National Allergy Council best practice guidelines for anaphylaxis prevention and management in schools.</div></div><div><h3>Methods</h3><div>Developed in consultation with key stakeholders in health and education settings, the best practice guidelines incorporate 7 key recommendations for anaphylaxis prevention and management: an allergy aware approach; anaphylaxis management policy and plans; allergy documentation; emergency response; staff training; community and student education; and postincident management and incident reporting.</div></div><div><h3>Results</h3><div>An audit of Australian state and territory education department anaphylaxis guidelines, policies, and procedures indicates that most align with best practice recommendations.</div></div><div><h3>Conclusions</h3><div>Ongoing reporting and evaluation of anaphylaxis incidents across all 8 jurisdictions in Australia helps us evaluate the implementation of these measures in the school setting.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100413"},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of serum IL-36 subfamily cytokines on clinical manifestations of asthma","authors":"Yuki Hoshino MD,&nbsp;Tomoyuki Soma MD, PhD,&nbsp;Kazuyuki Nakagome MD, PhD,&nbsp;Reina Ishii MD,&nbsp;Tatsuhiko Uno MD,&nbsp;Kazuki Katayama MD,&nbsp;Hidetoshi Iemura MD,&nbsp;Erika Naitou MD,&nbsp;Takahiro Uchida MD, PhD,&nbsp;Yoshitaka Uchida MD, PhD,&nbsp;Hidetoshi Nakamura MD, PhD,&nbsp;Makoto Nagata MD, PhD","doi":"10.1016/j.jacig.2025.100419","DOIUrl":"10.1016/j.jacig.2025.100419","url":null,"abstract":"<div><h3>Background</h3><div>The IL-36 subfamily, a member of the IL-1 superfamily, is thought to promote type 2 (T2) and non-T2 inflammation and involved in autoimmune and airway disease progression. However, its role in asthma remains unclear.</div></div><div><h3>Objective</h3><div>We sought to determine the contribution of the IL-36 subfamily to the clinical manifestation of asthma.</div></div><div><h3>Methods</h3><div>The levels of serum IL-36α, IL-36β, and IL-36γ, recognized as IL-36 subfamily agonists, and IL-36 receptor antagonist (IL-36Ra) and IL-38, recognized as IL-36 subfamily antagonists, were measured by ELISA in 110 asthma patients (55 with nonsevere and 55 with severe asthma) aged ≥20 years and 31 healthy individuals. The association of IL-36 with clinical indices and inflammatory mediators was examined. The characteristics of high and low IL-36 subgroups were explored.</div></div><div><h3>Results</h3><div>IL-36α, IL-36γ, and IL-36Ra levels were significantly higher in asthma patients, especially patients with severe asthma, than in healthy controls. The high IL-36γ group exhibited lower Asthma Control Test scores (<em>P</em> = .01), more frequent asthma exacerbations (AEs), and higher hazard ratio for AEs. The high IL-36Ra group exhibited higher values of forced expiratory volume in 1 second, more frequent severe AEs, and higher hazard ratio for severe exacerbations. The IL-36 cytokine levels, except for IL 36α, were positively correlated with IL-6, IL-13, IL-17, and/or IFN-γ levels. IL-36Ra was positively correlated with age-adjusted forced expiratory volume and forced vital capacity.</div></div><div><h3>Conclusion</h3><div>A systemically high IL-36 level is associated with asthma severity and with both T2 and non-T2 cytokines, and it implies poor condition and enhancement of risk of AEs in asthma patients.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100419"},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143550010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tezepelumab for asthma with current or previous smoking habit: Case series","authors":"Yoshiro Kai MD, PhD ,&nbsp;Kentaro Suzuki MD ,&nbsp;Ryosuke Kataoka MD","doi":"10.1016/j.jacig.2025.100420","DOIUrl":"10.1016/j.jacig.2025.100420","url":null,"abstract":"<div><div>Tezepelumab effectively treated severe asthma in a current smoker and a former smoker, suggesting that thymic stromal lymphopoietin is involved in the pathogenesis of severe asthma in these patients. Tezepelumab may additionally be used for severe asthma in current and former smokers.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100420"},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143332643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidisciplinary care in pediatric severe asthma: A comparative outcomes analysis","authors":"Adam S. Price MD ,&nbsp;Akilah A. Jefferson-Shah MD ,&nbsp;Robert D. Pesek MD ,&nbsp;Erhan Ararat MD ,&nbsp;Safia F. Nawaz MD ,&nbsp;Matthew Pertzborn MD ,&nbsp;Kim Cobb RT ,&nbsp;Haley Long RT ,&nbsp;Monica Y. Miller LMSW ,&nbsp;Brandi N. Whitaker PhD ,&nbsp;Stacie M. Jones MD ,&nbsp;Scott Stewart MS ,&nbsp;Daniel Liu MD ,&nbsp;Tamara T. Perry MD","doi":"10.1016/j.jacig.2025.100417","DOIUrl":"10.1016/j.jacig.2025.100417","url":null,"abstract":"<div><h3>Background</h3><div>There are limited data comparing the effectiveness of multidisciplinary severe asthma clinics (SACs) with that of conventional single-discipline clinics (SDCs) for pediatric severe asthma.</div></div><div><h3>Objective</h3><div>Our aim was to compare asthma outcomes between SACs and SDCs clinics and examine longitudinal health outcomes for patients with severe asthma who were followed in SACs.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study comparing pediatric asthma outcomes among patients with severe asthma between 2018 and 2022 who were treated at the multidisciplinary Arkansas Children's SAC with those of patients with severe asthma treated at SDCs. The primary outcome was acute health care utilization, including hospitalizations and emergency department visits. Secondary outcomes included systemic corticosteroid prescriptions and controller medications. For SAC enrollees, longitudinal outcomes including health care utilization, symptom control, and spirometry were evaluated 12 months before and after enrollment. Data sources included the electronic health record and SAC patient registry.</div></div><div><h3>Results</h3><div>The study population included 280 patients with severe asthma, aged 5 to 18 years, from the SAC (n = 56) and SDCs (n = 224). The SAC patients were more likely to be Black (79% vs 52% [<em>P</em> = .0002]), be non-Hispanic (100% vs 88% [<em>P</em> = .01]), have had at least 1 hospitalization (21% vs 10% [<em>P</em> = .04]), and have received at least 2 prescriptions for a systemic corticosteroid (34% vs 17% [<em>P</em> = .01]). Longitudinal outcomes among patients for the 12 months before SAC enrollment versus 12 months after SAC enrollment demonstrated significant reductions in acute exacerbations (from 35 to 8 [<em>P</em> &lt; .001]), hospitalizations (from 21 to 1 [<em>P</em> &lt; .001]), and intensive care unit admissions (from 8 to 1 [<em>P</em> = .02]).</div></div><div><h3>Conclusions</h3><div>The study highlights significant morbidity among predominately Black pediatric patients with severe asthma, particularly those followed in a SAC versus in SDCs at a tertiary care referral center. The findings demonstrate the value of targeted multidisciplinary approaches to reduce asthma utilization and improve outcomes among high-risk patients.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100417"},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143332867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multicomponent intervention for schoolchildren with asthma: Pilot cluster randomized controlled trial","authors":"Marina Reznik MD, MS ,&nbsp;Florinda Islamovic MD ,&nbsp;Jill S. Halterman MD, MPH ,&nbsp;Cheng-Shiun Leu PhD ,&nbsp;Jiaqing Zhang PhD ,&nbsp;Philip O. Ozuah MD, PhD","doi":"10.1016/j.jacig.2025.100418","DOIUrl":"10.1016/j.jacig.2025.100418","url":null,"abstract":"<div><h3>Background</h3><div>Physical activity (PA) is an important factor in asthma management. However, studies report low PA in children with asthma living in underserved communities.</div></div><div><h3>Objective</h3><div>We assessed preliminary effectiveness of a pilot multicomponent asthma intervention that includes classroom-based PA, asthma education to increase knowledge and reduce stigma, and care coordination to facilitate guideline-based care, on PA and symptom-free days (SFD) in urban, historically marginalized children with asthma.</div></div><div><h3>Methods</h3><div>Children aged 7-10 years with asthma and their caregivers were recruited from 4 Bronx, NY, schools. We randomly assigned 2 schools as intervention and 2 as control sites. Child PA (primary outcome) was measured by accelerometers at 4 time points, and caregivers completed surveys on asthma symptoms. Analyses used generalized linear mixed models with generalized estimating equation adjusting for clustering. Clinical Trial Registration: <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> NCT01873755.</div></div><div><h3>Results</h3><div>We included 107 children (53% male participants, 82% Hispanic, mean [standard deviation] age 9.0 [1.0] years, 76% with persistent or uncontrolled asthma). Children in the intervention group had a significantly greater increase in total moderate-to-vigorous PA and step counts at 12 months after intervention in the entire sample (β = 6.05, <em>P</em> &lt; .0001; β = 579.11, <em>P</em> = .008, respectively) and in those with persistent or uncontrolled asthma compared to controls (β = 6.20, <em>P</em> &lt; .001; β = 639.08, <em>P</em> = .004, respectively). Similar beneficial intervention effects were found in improvement in SFD over 2 weeks in the entire sample (β = 1.38, <em>P</em> = .018) and in children with persistent or uncontrolled asthma (β = 1.82, <em>P</em> = .011) compared to controls.</div></div><div><h3>Conclusion</h3><div>A pilot intervention addressing multiple barriers to PA, including stigma, teacher confidence in asthma management, access to PA, and in-school medication, improved PA levels and SFD in students with asthma.</div></div>","PeriodicalId":75041,"journal":{"name":"The journal of allergy and clinical immunology. Global","volume":"4 2","pages":"Article 100418"},"PeriodicalIF":0.0,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143332868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}