Acute Blood Allergy Testing Associated with Fewer Pediatric Asthma Hospitalizations

James Brock, DO

Children who are hospitalized due to asthma have improved outpatient disease management and exacerbation rates when atopically diagnosed with immunocap radioallergosorbent tests (RAST), according to a new study.

Researchers from the Miller Children’s & Women’s Hospital Long Beach in Long Beach, CA have found the radioimmunoassay test that detects antibody Immunoglobulin E (IgE) to indicate allergies is beneficial not only to responding physicians, but for the families and guardians of pediatric asthma patients.

While presenting the new study at the 2018 American Thoracic Society (ATS) International Conference in San Diego, CA, James Brock, DO, of the pediatric pulmonary division at the hospital, told MD Magazine pediatric and young adult patients that are hospitalized due to asthma at his facility are distinguished for RAST depending on their clinical history, current presentation, and if there’s indication for allergy-based intervention.

Brock and colleagues conducted the retrospective study by simply looking back at the patient groups split between either receiving or not receiving RAST during their hospitalization, and analyzing for outcomes.

Researchers pulled 273 subjects who met criteria after being hospitalized between June 2008 and October 2015, and having persistent asthma. Among the population, 207 (75.8%) of patients underwent RAST during their initial stay for exacerbation, while 66 (24.2%) did not. They assessed time from patient discharge to first emergency room (ER) visit, required systemic steroids, and next hospitalization for both patient populations. Results were stratified by baseline severity and adjusted for age, gender, and race.

At enrollment, the average patient age was 9.6 years, with 62% reported as male, 46.2% as African-American, and 41.4% as Hispanic. Mean hospitalization stay was 3.8 days, and systemic steroid duration during initial hospitalization was 6.1 days.

Among the population to receive RAST, a majority (69%) were found to have extremely elevated IgE levels above 300 IU/mL. However, the serum allergy evaluation conducted in standard RAST reduced the hazard of an ER visit and required corticosteroid treatment by half in patients with mild persistent asthma (P < 0.05).

The average time to next ER visit was nearly 1 year in the RAST group, while non-RAST patients returned to the ER in less than 6 months on average, according to the study. Though its probability value is not indicative of statistical significance, researchers also found the hazard of a subsequent hospitalization was reduced by more than half in adolescent patients with moderate-to-severe asthma who underwent RAST, versus those who did not (HR = 0.32; P = 0.10).

Brock said the statistically significant improvements in prolonged next hospitalization and required corticosteroid therapy stood out as surprising findings. The impact of the study — as it pertains to the most chronic condition that develops in children &mdash; speaks for itself.

“By doing acute testing for a chronic disorder, we’re able to help better manage these children and young adults with asthma,” Brock said. “It can make a huge impact at other levels as well — with their families, with their work, with the overutilization of the ER, and with the outcomes in their health.”

Researchers indicated a cost-utilization analysis will follow up on the study’s results, and Brock said the study can be expanded to include the recent years following the 2015 cutoff date.

“It actually can become prospective to include an even better-powered study, and potentially show statistically significant improvements in asthma management in moderate-to-severe persistent and other age populations,” Brock said.

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