Severe, Poorly Controlled Pediatric Asthma Worsened by Allergen Sensitization

In children with severe or poorly controlled asthma, those with allergen sensitization have been shown to experience more asthma exacerbations, to use more asthma-related healthcare resources and oral corticosteroids (OCS), and to have higher asthma-associated expenses compared with those without allergen sensitization, according to study results published in The Journal of Allergy and Clinical Immunology: In Practice.

Investigators conducted a retrospective, observational study on the topic conducted in children from the MarketScan^® Commercial and Medicaid databases. The researchers sought to explore the effect of allergen sensitization on asthma exacerbations, healthcare utilization, and costs in children with severe or poorly controlled asthma in both private (MarketScan Commercial) and public (Medicaid) insurance settings. The current study followed children who had been enrolled in health insurance plans for at least 12 months via use of data from health insurance claims that had been submitted by healthcare professionals to healthcare payers for reimbursement of such services as hospitalizations, emergency department (ED) visits, office visits, and outpatient pharmacy filling of prescriptions.

Patients’ allergen sensitization status was based on diagnoses of allergic conditions and extrinsic asthma.  An exacerbation of asthma was described as evidence of at least 1 of the following: inpatient admission with asthma as the primary diagnosis;  an ED visit with an asthma diagnosis as the first diagnosis position on the claim; or outpatient pharmacy claim for OCS with a supply of <fewer than 5 days (known as an OCS “burst”). Asthma-related healthcare costs comprised all medical and pharmacy expenses paid for asthma-related events.

All study participants were between 6 and 11 years of age. Of the patients who had severe or poorly controlled asthma, approximately 30% had allergen sensitization (private insurance: n=11,448; Medicaid: n=10,800), 20% did not have allergen sensitization (private insurance: n=7744; Medicaid: n=6535), and the allergen sensitization status could not be determined in the remainder of the patients. On average, claims data were available for at least 3 years.

Use of high-dose inhaled corticosteroids was significantly more common in children with allergen sensitization compared with those without allergen sensitization. No statistically significant differences in prolonged OCS use were reported between the 2 cohorts. The average unadjusted cumulative OCS dose per person-year was significantly higher in children with allergen sensitization than in those without allergen sensitization (P <.001).

Unadjusted analyses showed the children with severe or poorly controlled asthma and allergen sensitization had more asthma exacerbations overall and more occurrences of each component of the definition of asthma exacerbation compared with children without allergen sensitization (P <.001). The most common component in all of the cohorts was OCS bursts.

The investigators concluded that the excess burden reported in children with allergen sensitization is in addition to the burden associated with having severe or poorly controlled asthma itself. Clinicians need to be mindful of the effect of allergen sensitization in children with severe or poorly controlled asthma, and consider a laboratory assessment for allergen sensitization that includes blood immunoglobulin E (IgE) testing, blood allergen-specific IgE skin tests, and referral to an allergist when necessary.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Teague WG, Iqbal A, Ding Y, Chipps BE, Zazzali JL. The added burden of allergen sensitization among children with severe or poorly-controlled asthma.  J Allergy Clin Immunol Pract. Published online September 16, 2020. doi:10.1016/j.jaip.2020.08.063