Assessing Asthma Exacerbation Susceptibility
Previous research indicates that 50% of patients with asthma report having had an exacerbation in the previous year despite the majority of these individuals reporting that they have “mild” disease. Few studies have assessed the characteristics and determinants of exacerbations. For a study, researchers assessed exacerbations and their associations among African Americans with asthma. Asthma control was assessed using the 5-item Asthma Control Questionnaire (ACQ5). The likelihood of a future exacerbation increased with worsening ACQ5 scores. The investigators identified an exacerbation susceptibility phenotype that was independent of asthma control and may require more precise therapeutic targeting.
Milk Allergy & QOL
Current data are lacking on quality of life (QOL) measures among patients with an allergy to cow’s milk. Patients who are allergic to cow’s milk (or their guardians) and were candidates for oral food challenge or desensitization completed a QOL questionnaire over a 3-year period for a study. Among respondents, 45% reported in the fields of “emotional impact” and “symptoms of disease” that food allergies affected their life in moderation. About 52% reported that they were affected somewhat by the negative repercussions of their allergy. Nearly half (49%) of participants reported that the impact of social and dietary restrictions was serious. Also, 55% said they were slightly affected by personal expectations regarding their disease and its repercussions. Additionally, 72% had only discrete future expectations regarding improvement of their disease.
Selecting Patients for Thermoplasty
Brochial thermoplasty (BT) is an endoscopic treatment for severe persistent asthma in which heat is applied to the small airway for 10 seconds, causing atrophy of the small muscles. BT is performed as three separate outpatient procedures 3 weeks apart. Anecdotal evidence suggests that cost and insurance approval are major obstacles to patient access to BT. Researchers at the University of Cincinnati created a comprehensive work-up for patients with severe persistent asthma in order to help obtain insurance approval. Among patients referred for BT, 74% were obese or morbidly obese. In addition, 80% were on oral corticosteroids, 90% were on inhaled corticosteroids, 95% were on long-acting beta-agonists, 96% were on short-acting beta-agonists, and 56% were on an anti-leukotriene receptor antagonist. Participants had an average FEV1 of 1.99 liters. Comorbidities included excessive dynamic airway collapse (30%), vocal cord dysfunction (8%), and laryngopharyngeal reflux (18%). Interestingly, only 44% of patients completed thermoplasty. Insurance approval was not given to 42% of patients who were good candidates for the treatment, and 14% were deemed inappropriate candidates for BT.
Oral Immunotherapy for Food Allergies
The prevalence of food allergies in the United States has increased significantly over the past 10 years, according to published data. With few options for treatment, there has been increasing interest in the potential of using food oral immunotherapy (FOIT). For a study, researchers assessed experiences and treatment outcomes among patients treated with FOIT over an 8-year period. Participants received FOIT doses beginning with less than 5 mcg of nuts or 100 mcg of other food proteins, with target protein doses of 3,600 mg (egg whites) to 8,000 mg (wheat) and 10,826 mg (four nuts). Of the 88% of patients who reached their target dose and began maintenance, egg-treated patients were more likely to do continue their therapy than milk- and peanut-treated patients. Peanut FOIT was discontinued primarily because of eosinophilic esophagitis-like oral immunotherapy-related gastrointestinal syndrome or systemic reactions. Among peanut-treated participants who reached maintenance, about 9% later discontinued treatment.
Understanding Beta Lactam Allergy Prevalence
Previous studies show that approximately 90% of patients who avoid penicillin as a class of antibiotics appear to be tolerant of these medications upon allergy testing. Other research indicates that most patients with a true penicillin allergy lose their sensitivity to this reaction over time. Patients who are deemed “penicillin allergic” tend to have poorer health outcomes and accrue higher healthcare costs. For a study, researchers conducted a chart review of patients with a recent history of a reaction to a beta-lactam antibiotic who were subsequently evaluated for beta-lactam allergies. Less than 1% of patients in the study had positive intradermal tests or reacted with an oral drug provocation test with symptoms consistent with immunoglobulin E-mediated hypersensitivity. Overall, about 96% of participants did not require future avoidance of any beta lactam antibiotic. Additionally, a higher risk of anaphylaxis was ruled out in more than 99% of cases.
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