Advances in asthma: New understandings of asthma's natural history, risk factors, underlying mechanisms, and clinical management.

The last 2 years yielded a proliferation of high-quality asthma research. These include new understandings of the incidence and natural history of asthma, findings on the effects of exposure to air pollution, allergens, and intake of acetaminophen, soy isoflavones, and polyunsaturated fatty acids, and exposure to microbial products. The past 2 years have benefited from great strides in determining potential mechanisms of asthma development and asthma exacerbations. These novel understandings led to identification and development of exciting new avenues for potential therapeutic intervention. Finally, there has been significant progress made in the development of tools to facilitate the diagnosis of asthma and measurement of airway physiology and in precision diagnostic approaches. Asthma guidelines were updated and new insights into the pharmacologic management of patients, including biologics, were reported. We review the most notable advances in the natural history of asthma, risk factors for the development of asthma, underlying mechanisms, diagnostic approaches, and treatments. Although greater knowledge of the mechanisms underlying responses and nonresponses to novel therapeutics and across asthma phenotypes would be beneficial, the progress over just the past 2 years has been immense and impactful.

Emergency Call Characteristics and EMS Dispatcher Protocol Adherence for Possible Anaphylaxis.

Objective: Anaphylaxis is a medical emergency requiring prompt recognition and treatment with intramuscular epinephrine to optimize outcomes. To date, there is a paucity of data regarding the demographic characteristics of the subset of patients calling 9-1-1 for allergic reactions and the emergency medical services (EMS) dispatcher's adherence to national protocols for their response to a suspected allergic reaction. Methods: We conducted a retrospective review of dispatch calls to a local municipality that were dispatched with an impression of an "allergic reaction" or "difficulty breathing related to a suspected allergic reaction" from January 2016 to June 2016. Using a modified Delphi approach, the voice recordings of the calls were reviewed for EMS dispatcher adherence to the Medical Priority Dispatch System v12.2 (2012) triage questions and pre-arrival instructions for the Allergies/Envenomations and Breathing Problems protocols. The calls were further reviewed for demographic characteristics, symptomatology, history of allergy, suspected trigger of the current reaction, and use and availability of medications. Calls were also classified as to whether the patient met criteria for anaphylaxis. We calculated frequencies for categorical measures and medians with ranges for continuous measures. Results: A total of 146 calls met inclusion criteria. The median age of patients was 29 years (interquartile range 13, 52). 12.3% (n = 18) of the calls reviewed were consistent with national standards for anaphylaxis. Food was the most commonly reported historical allergy, whereas medication accounted for the most commonly suspected trigger for the current symptoms. The EMS dispatcher asked about alertness, difficulty breathing, difficulty speaking, and color change in 39.7, 80.1, 12.3, and 2.7% of calls, respectively. While 56.2% of dispatchers inquired about a history of severe allergy, only 16.4% inquired about prescribed special injections. Conclusions: The majority of calls were not consistent with anaphylaxis, and EMS dispatchers rarely strictly followed the Medical Priority Dispatch System guidelines aimed at identifying anaphylaxis. Future studies would be beneficial to determine if our findings hold true in other EMS service areas.

Real-world evaluation of a mobile health application in children with asthma.

BACKGROUND: Mobile health applications for asthma are increasingly being developed. However, there are no published randomized controlled trials evaluating efficacy in decreasing exacerbations. OBJECTIVE: To evaluate the impact of a mobile asthma application for asthma-related urgent health care usage. METHODS: We conducted a 6-month prospective randomized controlled trial for patients (6 months-21 years old) with persistent asthma presenting with an asthma exacerbation to the emergency department of a pediatric academic medical center. Participants were randomized to AsthmaCare (application providing medication and trigger reminders and treatment plan) or the control (online asthma information). Primary outcome measures were comparison of emergency department and urgent care visits and hospitalizations 6 months before and after randomization. RESULTS: AsthmaCare participants (n = 98) were slightly older (7.84 vs 6.24 years; P = .02) than controls (n = 95) but similar for sex (55% vs 62% boys), race (83% vs 77% African American), and insurer (89% vs 98% Medicaid). The 2 groups were similar in having more than 2 comorbidities (34% vs 32%) and receiving National Heart, Lung, and Blood Institute step 3 treatment or higher (69% vs 57%). There was no significant decrease in emergency department or urgent care visits or hospitalizations between the intervention and control groups. AsthmaCare participants were more likely to report improvement in asthma management 6 months after study enrollment (79% vs 64%; P = .06). CONCLUSION: This randomized controlled trial did not demonstrate a significant decrease in asthma-related emergency department visits or hospitalizations among children who used a mobile health application. TRIAL REGISTRATION: ClinicalTrials.gov, Identifier NCT02333630.

Food allergy prevalence and management at an overnight summer camp.

BACKGROUND: In recent years, increased awareness of food allergy management has focused on the school setting. A lack of awareness and relevant literature prompted evaluation of the camp experience. OBJECTIVE: To characterize the prevalence of food allergies among children attending an overnight summer camp and to evaluate the knowledge and comfort of camp personnel before and after a training session. METHODS: The database for the 2014 season at Flying Horse Farms was reviewed for information pertaining to food allergies and provision of epinephrine and treatment plans. Camp personnel completed surveys regarding food allergy knowledge and comfort. Surveys were redistributed 30 days after the training session. RESULTS: Among 445 campers, 15% reported at least one food allergy, with 8.5% reporting allergy to 1 of the top 8 food allergens. Only 32% of campers with food allergy supplied an epinephrine autoinjector, and 0% provided written treatment plans. Before training, 84% of personnel desired additional information about food allergies. Knowledge of food allergies among personnel was high at baseline but increased after training in regard to epinephrine use for anaphylaxis and postepinephrine management. Staffers who reported feeling very comfortable caring for campers with food allergy increased from 16% to 46% after the training session; comfort in treating a food allergy emergency increased from 2% to 29%. CONCLUSION: Management of food allergies at overnight summer camps warrants similar education and preparation strategies as those implemented in schools. Camp personnel should receive annual training regarding food allergies and anaphylaxis.

Asthma, severe acute respiratory syndrome coronavirus-2 and coronavirus disease 2019.

PURPOSE OF REVIEW: In December 2019, a novel respiratory illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described and named coronavirus disease 2019 (COVID-19). Although the knowledge base surrounding COVID-19 and SARS-CoV-2 has grown rapidly, significant gaps in our knowledge remain and inaccurate information continues to circulate. This review will discuss the interaction between asthma and COVID-19 to provide a comprehensive understanding based on the currently available published data. RECENT FINDINGS: Non-SARS human coronaviruses (HCoVs) are a significant cause of asthma exacerbations, but SARS-CoV-2 does not appear to exacerbate asthma. Data thus far strongly suggest that patients with asthma are at no increased risk of infection with SARS-CoV-2 or more severe disease if infected with COVID-19. Although the data are extremely limited on inhaled corticosteroids and biologic medications, there remain no data suggesting that these therapeutics positively or negatively impact the severity or outcome of COVID-19. SUMMARY: Data are rapidly evolving regarding COVID-19 and asthma. At this time, asthma does not appear to positively or negatively affect outcomes of COVID-19; however, it is imperative that practitioners keep abreast of the changing literature as we await a vaccine and control of this pandemic.

Establishing Standardized Documentation for Anaphylaxis Treatment in a Tertiary Care Pediatric Allergy Clinic.

INTRODUCTION: Anaphylaxis is a potentially life-threatening allergic reaction. Common allergy clinic procedures, including oral food challenges and subcutaneous immunotherapy, carry a risk of anaphylaxis, the treatment for which is epinephrine. Our goal was to develop a standardized process for the management and documentation of allergic reactions that occur in a tertiary care pediatric allergy clinic. METHODS: This was a single institution quality improvement pilot study. A multidisciplinary team from the allergy department designed, implemented, and studied the use of a standardized form for the documentation and treatment of allergic reactions within the clinic. RESULTS: A standardized form was developed based on evidence-based guidelines for the management of allergic reactions and included space for documentation. Both clinic providers and staff approved the form. One year after the introduction, we reached 100% adherence for the use of the form in visits during which a patient experienced a severe allergic reaction requiring epinephrine. Two patients required transfer to the emergency room; the quality improvement form was utilized in these cases to document treatment and assist with the hand-off to emergency room personnel before transfer. CONCLUSIONS: We successfully implemented a standardized form for the treatment and documentation of anaphylaxis within our allergy clinic. The next steps focus on further integrating this form into the electronic medical record, determining compliance with evidence-based management of anaphylaxis, and formally assessing the use of the form as a handoff tool in the event of patient transfer.