Test for respiratory and asthma control in preschool kids in the emergency department as a predictor of wheezing exacerbations

Prediction of Asthma Exacerbations in Children

Asthma exacerbations are common in asthmatic children, even among those with good disease control. Asthma attacks result in the children and their parents missing school and work days; limit the patient's social and physical activities; and lead to emergency department visits, hospital admissions, or even fatal events. Thus, the prompt identification of asthmatic children at risk for exacerbation is crucial, as it may allow for proactive measures that could prevent these episodes. Children prone to asthma exacerbation are a heterogeneous group; various demographic factors such as younger age, ethnic group, low family income, clinical parameters (history of an exacerbation in the past 12 months, poor asthma control, poor adherence to treatment, comorbidities), Th2 inflammation, and environmental exposures (pollutants, stress, viral and bacterial pathogens) determine the risk of a future exacerbation and should be carefully considered. This paper aims to review the existing evidence regarding the predictors of asthma exacerbations in children and offer practical monitoring guidance for promptly recognizing patients at risk.

Modeling the conversion between specific IgE test platforms for nut allergens in children and adolescents

BACKGROUND

Multiplex tests allow for measurement of allergen-specific IgE responses to multiple extracts and molecular allergens and have several advantages for large cohort studies. Due to significant methodological differences, test systems are difficult to integrate in meta-analyses/systematic reviews since there is a lack of datasets with direct comparison. We aimed to create models for statistical integration of allergen-specific IgE to peanut/tree nut allergens from three IgE test platforms.

METHODS

Plasma from Canadian and Austrian children/adolescents with peanut/tree nut sensitization and a cohort of sensitized, high-risk, pre-school asthmatics (total n = 166) were measured with three R&D multiplex IgE test platforms: Allergy Explorer version 1 (ALEX) (Macro Array Dx), MeDALL-chip (Mechanisms of Development of Allergy) (Thermo Fisher), and EUROLINE (EUROIMMUN). Skin prick test (n = 51) and ImmunoCAP (Thermo Fisher) (n = 62) results for extracts were available in a subset. Regression models (Multivariate Adaptive Regression Splines, local polynomial regression) were applied if >30% of samples were positive to the allergen. Intra-test correlations between PR-10 and nsLTP allergens were assessed.

RESULTS

Using two regression methods, we demonstrated the ability to model allergen-specific relationships with acceptable measures of fit (r²  = 94%-56%) for peanut and tree nut sIgE testing at the extract and molecular-level, in order from highest to lowest: Ara h 2, Ara h 6, Jug r 1, Ana o 3, Ara h 1, Jug r 2, and Cor a 9.

CONCLUSION

Our models support the notion that quantitative conversion is possible between sIgE multiplex platforms for extracts and molecular allergens and may provide options to aggregate data for future meta-analysis.

The Relationship of the Test for Respiratory and Asthma Control in Kids Initial Score on the Prognosis of Pre-school Children With Asthma: A Prospective Cohort Study

Objective: The test for respiratory and asthma control in kids (TRACK) is currently the only standard follow-up tool for children under 5 years of age with asthma. The purpose of this study was to investigate the relationship between the TRACK initial score (Ti) and their prognosis after 6 months of follow-up in pre-schoolers with asthma. Design: A prospective cohort study. Methods: The study included pre-schoolers diagnosed with asthma at the Shanghai Children's Medical Center between January 2019 and June 2020, and follow-up for 6 months. TRACK scores, frequency of wheezing and respiratory infections, number of Emergency Department (ED) visits and treatment regimen were collected. According to the TRACK initial score, the children were divided into "Ti < 60 group" and "Ti ≥ 60 group," and the two groups were compared in terms of TRACK score related indicators, clinical manifestations and treatment. Results: There are 102 pre-schoolers included in the analysis [78 boys (76.5%) and 24 girls (23.5%); mean (SD) age, 28.05 (11.63) months]. After 6 months of follow-up, the TRACK score was improved in both groups, and the "Ti ≥ 60 group" had a higher score, lower rate of uncontrolled asthma and fewer reassessments were required. There was no difference in the number of wheezing attacks between the two groups in terms of clinical presentation, but the "Ti < 60 group" had more respiratory infections and ED visits. Regarding the use of ICSs, in the "Ti < 60 groups," the dose of ICSs was higher and reduced slowly, and the dose difference between the two groups began to appear after 5 months of follow-up. Conclusion: TRACK is essential for pre-schoolers with asthma at the time they are diagnosed. In addition, if the TRACK initial score is < 60, the probability of poor prognosis is higher.