Favorable response to asthma-dosed subcutaneous mepolizumab in eosinophilic pneumonia.

Introduction: Mepolizumab targets eosinophils in the treatment of asthma. The dose used for asthma is considerably lower than that used for treating eosinophilic granulomatosis with polyangiitis, a recently approved indication. While intravenous mepolizumab use has reported utility in non-asthma eosinophilic disorders, the efficacy of the subcutaneous asthma dosing of the drug for eosinophilic pneumonia is not known. Case study: A middle-aged female was diagnosed with eosinophilic pneumonia. The patient's clinical/radiologic/laboratory findings, response to treatment, and respiratory function studies are described. Results: A woman, born in 1962, had repeated pneumonia hospitalizations from 2007 through 2010. In October 2010, a lung biopsy showed findings consistent with chronic eosinophilic pneumonia and chronic asthma. The patient also had chronic sinusitis. Long term systemic corticosteroids were prescribed but the patient became oxygen dependent by 2014. Omalizumab was administered for 1 year starting in 2015 without improvement in symptoms. In 2016, mepolizumab 100 mg subcutaneously every 4 weeks was initiated. Symptomatic improvement with decreased oxygen and systemic corticosteroid requirements were noted. A chest CT performed in February 2018 showed marked improvement compared to a study in 2016. Interval spirometric improvements were noted. Peripheral blood eosinophils/mm3 prior to mepolizumab were 237, and while on mepolizumab were 10. Conclusion: Parenchymal eosinophilic lung disease may respond to asthma-dosed mepolizumab. Mepolizumab treatment in asthma where concomitant interstitial disease is suspected, may offer an advantage over omalizumab in the ability to reduce eosinophils not only in airways, but also in lung parenchyma.

The Epidemiology of Anaphylaxis.

Anaphylaxis is a dramatic expression of systemic allergy. The lifetime prevalence of anaphylaxis is currently estimated at 0.05-2 % in the USA and ~3 % in Europe. Several population-specific studies have noted a rise in the incidence, particularly in the hospitalizations and ER visits due to anaphylaxis. The variable signs and symptoms that constitute the diagnostic criteria for anaphylaxis, the differences in diagnostic algorithms, and the limitations in the current coding systems have made summarizing epidemiologic data and comparing study results challenging. Nevertheless, across all studies, the most common triggers continue to be medications, food, and venom. Various risk factors for more severe reactions generally include older age, history of asthma, and having more comorbid diseases. Interesting seasonal, geographic, and latitude differences have been observed in anaphylaxis prevalence and incidence rates, suggesting a possible role of vitamin D and sun exposure in modifying anaphylaxis risk. While the incidence and prevalence of anaphylaxis appear to be increasing in certain populations, the overall fatality rate remains relatively low.

Disproportionate effects of dementia on hospital discharge disposition in common hospitalization categories.

BACKGROUND: The impact of dementia on hospitalization discharge dispositions (HDDs) in the United States has not been quantified, and dementia prevalence in various hospitalization categories has not been detailed in recent years. OBJECTIVE: To characterize hospitalizations prevalent with dementia, and to examine the relationship between dementia and HDDs. DESIGN: A retrospective cross-sectional study. SETTING: 2000 to 2012 National Inpatient Sample databases. PATIENTS: Hospitalizations in persons ≥65 years old assigned to 1 of 12 Diagnosis Related Groups (DRGs) with a high number of dementia patients. INTERVENTION: None. MEASUREMENTS: The databases were queried for 12 DRGs (versions 18/24). Predictor effects for dementia on HDD categories were modeled adjusting for other defined comorbidities/covariates using logistic regression. Adjusted predictor effects of dementia on HDD in the DRG groupings were determined. Dementia prevalence and trends were assessed. RESULTS: Increasing proportions of dementia were noted in 4 DRGs studied. Dementia was strongly associated with being discharged to a nonhome setting. The most marked dementia effects were noted in DRGs 174 (gastrointestinal hemorrhage), 88 (chronic obstructive pulmonary disease), 182 (esophagitis/gastroenteritis), 138 (cardiac arrhythmias), 127 (congestive heart failure), and 89 (simple pneumonia and pleurisy), where there was at least a 76% reduction in the adjusted odds ratio (0.18-0.24) for home discharge. In contrast, DRGs 14 (stroke), 79 (respiratory infections/ inflammations), and 320 (kidney/urinary infections) had a smaller reduction in dementia-associated adjusted odds ratio (0.41-0.46) for home discharge. DRGs 79 and 320 had the highest proportions of dementia (>10%). CONCLUSIONS: Dementia proportions in many hospitalization categories have increased. The variable effect of dementia on home discharge suggests that dementia has a differential influence on hospital discharge disposition depending on the DRG. These findings have implications for healthcare allocation and long-term care planning.

Fatal anaphylaxis in the United States, 1999-2010: temporal patterns and demographic associations.

BACKGROUND: Anaphylaxis-related deaths in the United States have not been well characterized in recent years. OBJECTIVES: We sought to define epidemiologic features and time trends of fatal anaphylaxis in the United States from 1999 to 2010. METHODS: Anaphylaxis-related deaths were identified by using the 10th clinical modification of the International Classification of Diseases system diagnostic codes on death certificates from the US National Mortality Database. Rates were calculated by using census population estimates. RESULTS: There were a total of 2458 anaphylaxis-related deaths in the United States from 1999 to 2010. Medications were the most common cause (58.8%), followed by "unspecified" (19.3%), venom (15.2%), and food (6.7%). There was a significant increase in fatal drug-induced anaphylaxis over 12 years: from 0.27 (95% CI, 0.23-0.30) per million in 1999 to 2001 to 0.51 (95% CI, 0.47-0.56) per million in 2008 to 2010 (P < .001). Fatal anaphylaxis caused by medications, food, and unspecified allergens was significantly associated with African American race and older age (P < .001). Fatal anaphylaxis to venom was significantly associated with white race, older age, and male sex (P < .001). The rates of fatal anaphylaxis to foods in male African American subjects increased from 0.06 (95% CI, 0.01-0.17) per million in 1999 to 2001 to 0.21 (95% CI, 0.11-0.37) per million in 2008 to 2010 (P < .001). The rates of unspecified fatal anaphylaxis decreased over time from 0.30 (95% CI, 0.26-0.34) per million in 1999 to 2001 to 0.09 (95% CI, 0.07-0.11) per million in 2008 to 2010 (P < .001). CONCLUSION: There are strong and disparate associations between race and specific classes of anaphylaxis-related mortality in the United States. The increase in medication-related deaths caused by anaphylaxis likely relates to increased medication and radiocontrast use, enhanced diagnosis, and coding changes.

Adverse drug effects and angioedema hospitalizations in the United States from 2000 to 2009.

Since angiotensin-converting enzyme (ACE) inhibitors became common treatments, there have been increasing reports of angioedema (AE). AE hospitalization (AEH) trend data in the new millennium are limited. This study calculates hospitalization rates for AEs and describes clinical characteristics of AEHs in the United States, especially as related to specific adverse drug effects (ADEs). The National Inpatient Samples 2000-2009 were queried for AEHs to calculate hospitalization rates and to examine for associations with specified ADEs, certain comorbidities, and demographic features. AEHs requiring intubation or tracheostomy were also examined for associations. There was a significant increase in the AEH rates (3.4 per 10(5) to 5.4 per 10(5)) over the study period (p < 0.0001) and the hospitalization rates for African Americans (AAs) were consistently higher. Throughout the study the proportions of AEH coding any ADEs, or an ADE due to a cardiovascular (CV) or antihypertensive (aHTN) drug increased over time. By 2009, 61.7% AEHs coded an ADE. Of these, 58.7% were caused by CV or aHTN drugs. In AEHs, having an ADE from a CV or aHTN medication had the strongest adjusted associations with hypertension and renal disease as well as with alcohol-related disorders. In AEHs, intubation/tracheostomy had the strongest ADE associations related to CV or aHTN medication (adjusted odds ratio, 1.4; 95% CI, 1.3, 1.6). AEHs continue to increase, but this can only be partially attributed to ACE inhibitor usage. Intubation/tracheostomy appears to be greater in AEHs with ADE due to CV/aHTN drugs. Alcohol-related disorders may have a role in ACE inhibitor-associated AEH.

Evolution of end-of-life care at United States hospitals in the new millennium.

OBJECTIVE: To examine the characteristics of United States hospitalizations that result in hospice transfers including the clinical and demographic features, and to determine distinctive factors associated with discharges to hospice (DTH). METHODS: The National Inpatient Sample (NIS) databases for 2000-2009 were queried for hospitalizations which resulted in transfers to hospice and expiration in the hospital. Yearly totals, as well as demographic and clinical features were tabulated for DTH hospitalizations. These characteristics were also compared with hospitalizations that ended with expiration using multivariate regression. RESULTS: The number of DTH per year increased 15 fold from 27,912 in 2000 to 420,882 in 2009. The median hospital stay decreased, while the median age, proportion of sepsis disease related groups (DRGs), and proportion of Medicare hospitalizations increased. Lung, gastrointestinal, hepato-biliary, and brain cancer were consistently the most prevalent malignancy DRGs. However, the initial preponderance of hospitalizations with any diagnosis of cancer was diminished by the end of the study. The adjusted odds ratio (95%CI) for the prediction of DTH (compared to hospital death) by any diagnosis of cancer decreased from 3.61 (3.52-3.71) to 2.02 (2.00-2.04) from the years 2000-2009. Female gender, age, and chronic obstructive pulmonary disease were predictors of discharge to hospice, while congestive heart failure was inversely associated. CONCLUSIONS: Hospital discharges to hospice have increased over the past ten years, with a concomitant shift in clinical and demographic characteristics. A growing trend toward offering and adopting hospice care upon discharge from US hospitals will likely impact health care finance and quality of care measures.

Perspectives on anaphylaxis epidemiology in the United States with new data and analyses.

Anaphylaxis incidence rates and time trends in the United States have been reported using different data sources and selection methods. Larger studies using diagnostic coding have inherent limitations in sensitivity and specificity. In contrast, smaller studies using chart reviews, including reports from single institutions, have better case characterization but suffer from reduced external validity due to their restricted nature. Increasing anaphylaxis hospitalization rates since the 1990s have been reported abroad. However, we report no significant overall increase in the United States. There have been several reports of increasing anaphylaxis rates in northern populations in the United States, especially in younger people, lending support to the suggestion that higher anaphylaxis rates occur at higher latitudes. We analyzed anaphylaxis hospitalization rates in comparably sized northern (New York) and southern (Florida) states and found significant time trend differences based on age. This suggests that the relationship of latitude to anaphylaxis incidence is complex.

Measured immunoglobulin E in allergic bronchopulmonary aspergillosis treated with omalizumab.

BACKGROUND: The ability to assess adequate reductions in immunoglobulin E (IgE) in allergic bronchopulmonary aspergillosis (ABPA) has been a concern with regards to omalizumab treatment. OBJECTIVE: To describe the clinical course and serial measured IgE levels in two adult patients with elevated IgE levels, hypersensitivity to Aspergillus fumigatus, and bilateral bronchiectasis who were treated with omalizumab. CLINICAL DESCRIPTIONS: Patient 1 met commonly used criteria for ABPA and had a more than 3-fold increase (from 702 to 2462 IU/ml) in measured IgE 4 months after starting omalizumab. Two years after starting omalizumab, the IgE level decreased to baseline (473 IU/ml) even when corticosteroids were discontinued. Patient 2 had near normalization of elevated IgE levels when treated with corticosteroids but IgE levels subsequently rose again to over 10,000 IU/ml. After reducing the IgE level to 586 IU/ml with higher corticosteroid doses, omalizumab was initiated. Twenty months after starting omalizumab, the measured IgE was 510 IU/ml. Based on published omalizumab treatment­associated total/free IgE ratios, the estimated free IgE levels for both patients after more than a year of omalizumab treatment was less than their pre­omalizumab treatment IgE levels. CONCLUSIONS: These data suggest that omalizumab can be beneficial in treating ABPA and that measured IgE levels can still be useful in this context. Noting the pattern of IgE levels associated with ABPA exacerbations and with corticosteroid treatment may help both with achieving an IgE level appropriate for omalizumab treatment and with the interpretation of measured IgE changes associated with omalizumab treatment.

Clinical associations of delirium in hospitalized adult patients and the role of on admission presentation.

OBJECTIVE: To describe clinical associations of delirium in hospitalized patients and relationships to on admission presentation. DESIGN: Retrospective analysis of an administrative hospitalization database 1998-2007. SETTING: Acute care hospitalizations in the New York State (NYS). MEASUREMENTS: Four categories of diagnosis related group (DRG) hospitalizations were extracted from a NYS administrative database: pneumonia, congestive heart failure, urinary tract/kidney infection (UTI), and lower extremity orthopedic surgery (LEOS) DRGs. These hospitalizations were examined for clinical associations with delirium coding both on and after admission. RESULTS: Delirium was coded in 0.8% of the cohort, of which an on admission diagnosis was present in 59%. On admission delirium was strongly associated with dementia (adjusted odds ratio 0, 95%CI 5.8-6.3) and with adverse drug effects (ADEs) (adjusted odds ratio 4.6, 95%CI 4.3, 5.0). After admission delirium was even more highly associated with ADEs (adjusted odds ratio 22.2, 95%CI 20.7-23.7). The UTI DRG category had the greatest proportion of on admission delirium. However after admission delirium was more common in the LEOS DRG category. Over time, there was a greater increase in delirium proportions in the UTI DRG category, and an overall increase in coding for encephalopathy states (potential alternative delirium descriptors). CONCLUSION: ADEs play an important role in delirium regardless of whether or not it is present on admission. While the finding that most delirium hospitalizations presented on admission suggests that delirium impacts more as a clinical admitting determinant, in-hospital prevention strategies may still have benefit in targeted settings where after admission delirium is more frequent, such as patients with LEOS.

Drug-induced, dementia-associated and non-dementia, non-drug delirium hospitalizations in the United States, 1998-2005: an analysis of the national inpatient sample.

BACKGROUND: The incidence and pattern of delirium recorded in a broad spectrum of American hospitalizations has not been well described. The National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project is an administrative database of hospitalizations in the US that affords an opportunity to examine for International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) codes relating to delirium. OBJECTIVE: To examine the prevalence of delirium diagnoses and associated clinical factors, including adverse drug effects, in a broad spectrum of hospitalizations in the US. Delirium was grouped into three categories: drug-induced delirium, dementia-associated delirium, and non-dementia, non-drug (NDND). METHODS: Hospitalizations during the years 1998-2005 in the NIS databases were examined. These databases represent samples of hospitalizations that allow for national prevalence estimates. ICD-9 codes for drug-induced, dementia-associated and NDND delirium were identified in the hospitalizations for each year. Delirium tremens was not considered in this classification, and paediatric and psychiatric admissions were excluded. Yearly prevalence for drug-induced, dementia-associated and NDND delirium were tabulated, and time trends were analysed with negative binomial regression. A hospitalization subset cohort with urinary tract/kidney infection, pneumonia, heart failure and lower extremity orthopaedic surgery diagnosis-related group categories was also analysed for clinical associations with the presence of the three categories of delirium using multinomial logistic regression. ICD-9 E codes (external causes of injury) constituting adverse drug effects were identified and considered as clinical predictors. RESULTS: Delirium was recorded in 1 269 185 (0.54%) non-psychiatric adult hospitalizations during the study years. Whereas the overall prevalence of dementia-associated delirium and NDND delirium decreased over time, drug-induced delirium prevalence increased (p < 0.0001). As expected, the presence of dementia and adverse drug effects had the strongest associations with dementia-associated and drug-induced delirium, respectively, in the cohort hospitalizations. CONCLUSIONS: Drug-induced delirium and NDND delirium had the strongest associations with lower extremity orthopaedic surgery hospitalizations and urinary tract/kidney infection hospitalizations, respectively. Among the NDND co-morbid conditions, volume depletion and sodium imbalance had the strongest, albeit modest, associations with delirium. The association between decade of age and delirium was strongest for NDND delirium (adjusted odds ratio 1.53; 95% CI 1.52, 1.53), but age had significant associations with drug-induced and dementia-associated delirium as well. In the cohort, the most frequent adverse effects codes were for opioids and for benzodiazepines or other sedatives, which were noted in 21.3% and 15.2% of drug-induced delirium hospitalizations, respectively. Drug-induced delirium is being increasingly identified in hospitalized patients. Administrative hospitalization databases constitute a resource to explore factors and trends associated with delirium. The findings suggest that interventions focusing on adverse drug effects have the greatest potential for preventing delirium.

Omalizumab-associated anaphylactic reactions reported between January 2007 and June 2008.

BACKGROUND: Anaphylaxis associated with omalizumab treatment is a growing concern. The broader context in which omalizumab-associated allergic reactions occur has not been well described. OBJECTIVE: To identify and characterize recently reported anaphylactic reactions associated with omalizumab administration. METHODS: The US Food and Drug Administration Adverse Event Reporting System reports between January 1, 2007, and June 30, 2008, were queried for new reactions primarily suspected to be due to omalizumab. Reaction characteristics were analyzed for a reaction descriptor of anaphylactic or anaphylactoid shock or reaction and for dermal, respiratory, cardiovascular, and gastrointestinal reaction descriptor terms that in combination could be interpreted as constituting anaphylaxis. Associated narratives for these reports were obtained and were examined further. RESULTS: There were 85 cases with an anaphylaxis descriptor and 33 cases without a descriptor of anaphylaxis but with multisystem allergic reactions (mostly respiratory and skin or mucosal) that were consistent with anaphylaxis. Of these 118 cases, 32 were after the first dose and 14 were after the second dose of omalizumab. Seventy-seven of the 118 cases were categorized as requiring hospital admission or prolongation, had life-threatening reactions, underwent treatment with epinephrine or corticosteroids, or had omalizumab treatment withheld or discontinued. Nineteen of the 118 reactions were described as occurring within 1 hour of omalizumab injection. CONCLUSIONS: Allergic reactions to omalizumab continue to be reported. Some patients not labeled as having anaphylaxis have multisystem allergic reactions consistent with anaphylaxis, raising questions about the adequacy of the Food and Drug Administration categorizations. The characteristics of these patient reports point toward a spectrum of systemic allergic reactions associated with omalizumab use.

Incidence and impact of adverse effects to antibiotics in hospitalized adults with pneumonia.

BACKGROUND: This study sought to define the incidence, economic impact, and nature of adverse drug effects (ADEs) related to antibiotics in pneumonia hospitalizations in the US. METHODS: Adult pneumonia hospitalizations were tabulated in statewide (New York) and national databases, respectively, from 2000 through 2005. The incidences of antibiotic related ADEs were determined by identifying antibiotic specific e-codes (external cause of injury codes). The modeled effect of the presence of antibiotic ADEs on length of stay (LOS) and total charges were also calculated. ADEs due to specific antibiotic classes, and the presence of certain cutaneous allergic and gastro-intestinal manifestations commonly attributable to ADEs, were tabulated. RESULTS: ADEs related to antibiotics were reported in a small but consistent proportion (0.45-0.6%) of pneumonia hospitalizations in both cohorts. The most common identifiable antibiotics class associated with ADEs was the cephalosporins followed by penicillins and quinolones. Over 60% of the ADEs were associated with reported dermal/allergic and gastro-intestinal manifestations. Multivariate analysis adjusting for co-morbid conditions and demographic factors showed that the presence of an antibiotic adverse drug effect was a significant independent predictor of greater LOS and higher total hospital charges. CONCLUSIONS: ADEs related to antibiotics can be identified by analyzing administrative hospitalization databases. For pneumonia, a common hospitalization diagnosis, there is a defined calculable impact and incidence of antibiotic associated adverse effects. This should be considered in planning hospitalization resource allocation and in developing equitable hospitalization reimbursements. Identifying the nature of antibiotic associated adverse effects may facilitate the development of strategies for reducing these adverse effects.

The gender disparity in adult asthma hospitalizations dynamically relates to age.

Although it is known that women have a higher prevalence of asthma than men, it is not known whether and/or how gender differences in asthma severity are affected by age. Asthma hospitalization rates were compared for men and women in New York State from 1990 through 2006 between the ages of 20 and 84. Female and male hospitalization rates were calculated and characterized for the different age intervals. The ratio between female to male hospitalization rates were compared for different age groups. While males showed an overall linear increase in hospitalization rates with increasing age, women had a steeper increase in hospitalization rates followed by a slowing beginning at the ages between 40-54. The ratio of the female to male hospitalization rates was maximal in this age interval, with a mean ratio of 2.41 compared to 1.97 in other ages. For each year, this female to male ratio was consistently higher for the age range between 40 to 54 than for other ages, and this difference remained when admissions associated obesity, tobacco dependence, and chronic non-asthmatic pulmonary disease were excluded. Differences between the hospitalization rates for men and women vary by age. The gender gap in hospitalization rates appears to be maximal between the ages of 40 and 54. This may reflect age related asthma prevalence and/or severity differences between men and women.

Increasing anaphylaxis hospitalizations in the first 2 decades of life: New York State, 1990 -2006.

BACKGROUND: Although an increase in the occurrence of anaphylaxis has been reported in several parts of the world, this phenomenon has not been described in the United States. OBJECTIVE: To characterize anaphylaxis hospitalizations in New York State in patients younger than 20 years. METHODS: Using a statewide administrative database, hospital admissions of patients with an allergic disease (anaphylaxis, angioedema, urticaria, and allergy unspecified) as the primary diagnosis were analyzed from 1990 through 2006 in New York State. Admission rates were calculated for the allergic disease groups, as were hospitalization characteristics. Statistical modeling and group comparisons were performed with the use of negative binomial distribution analysis. RESULTS: For patients younger than 20 years, the anaphylaxis hospitalization rate increased by more than 4-fold during the study period and by 2002 exceeded the combined hospitalization rates for urticaria, angioedema, and unspecified allergy. After the widespread adoption of food anaphylaxis codes in 1994, food anaphylaxis predominated hospitalizations for anaphylaxis. Peanut was the most common food allergen in food anaphylaxis admissions. The anaphylaxis hospitalization rate for males was significantly greater than that of females (risk ratio, 1.45; 95% confidence interval, 1.26-1.66). Blacks were not disproportionately hospitalized for anaphylaxis. An overall bimodal age distribution showed peaks in the very young and in teens. CONCLUSION: These data demonstrate that in a populous Northeastern state in the United States, anaphylaxis requiring hospitalization is increasing in the age group younger than 20 years.

Increasing hospitalizations due to angioedema in the United States.

BACKGROUND: Angioedema may occur in patients taking angiotensin-converting enzyme inhibitors. With the more prevalent use of this class of medications in the United States, it is not known whether angioedema hospitalizations have increased nationally in recent years. OBJECTIVES: To profile the trends in angioedema hospitalizations and to examine associated demographic factors and comorbid diseases in the United States. METHODS: A national database of hospitalizations in the United States was queried for hospitalizations with a principal diagnosis of angioedema and other major acute allergic disorders (anaphylaxis, urticaria, and allergy unspecified). Subsequent analysis was performed to determine the current angioedema hospitalization trends (1998-2005) and to examine clinical and demographic variables that distinguished angioedema from the other allergic disease admissions. RESULTS: The angioedema hospitalization rate was 3.3 in 100,000 in 1998 and rose to 4.0 in 100,000 in 2005. In contrast, the combined hospitalization rate for nonangioedema allergic disorders showed an overall decline and was exceeded by angioedema hospitalization rates after 2000. African American patients had consistently higher hospitalization rates (> or = 2 times) for angioedema compared with non-African American patients. Hypertension, increasing age, and African American ethnicity were associated with angioedema hospitalizations. Twenty-four percent of hospitalizations for angioedema were coded for an adverse effect due to cardiovascular or antihypertensive agents. CONCLUSIONS: Angioedema has become the dominant allergic disorder that results in hospitalization in the United States. Angioedema hospitalizations have a distinct epidemiologic pattern that differs from that observed in other atopic disease hospitalizations.

Incrementos continuos de las hospitalizacionesdebidas a angioedema / Continued increases in hospitalizations due to angioedema

Es posible que las hospitalizaciones y las consultas a lasala de emergencias debidas a angioedema estén enaumento. En este estudio se determinó el patrón de losingresos hospitalarios por angioedema en el estado deNueva York para los años 1990 a 2005...

Hospitalizations and emergency visits due to angioedemamay be on the rise. In this study, the pattern of hospital admissions for angioedema in New York state were profiled for the years 1990 through 2005...

Asthma hospitalization patterns in young children relating to admission age, infection presence, sex, and race.

BACKGROUND: Although childhood hospitalizations for asthma are common, there are few detailed temporal and demographic descriptions of these hospitalizations. OBJECTIVE: To relate temporal patterns of asthma hospitalization in young children to admission age, sex, comorbid infection, and race. METHODS: Retrospective analysis of 151,391 New York State hospitalizations with a principal diagnosis of asthma between January 1, 1990, and December 31, 2004, in children younger than 5 years. Admission patterns across time were related to admission age, sex, race, and comorbid diagnoses of common infections. RESULTS: Although the overall hospitalization rate decreased, it was still 63.8 per 10,000 in 2004. Higher hospitalization rates were consistently observed in children younger than 3 years, African Americans, and boys. Fall increases and summer declines in overall monthly hospitalization rates and monthly median ages exemplified the seasonality observed in the study population. However, admissions with concomitant common infections peaked in the winter, not fall months. Sex did not affect the observed seasonality. Compared with white patients, African Americans not only manifested more than 3-fold higher hospitalization rates but also more repeated hospitalizations. CONCLUSIONS: The concurrent cyclical increases in median age and monthly admissions suggest that seasonal factors affecting older children may relate to fall increases in asthma admissions. These fall peaks are not accounted for by recognizable concomitant common respiratory tract infections. Understanding the basis for these seasonal variations may lead to prevention strategies that could decrease asthma admissions. Asthma hospitalizations in young children continued to be highly prevalent in New York State, especially in African American patients.