Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY
Volume 138, Issue 4, Pages 1016-1029Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jaci.2016.06.061
Keywords
Allergen sensitization; allergy; airway inflammation; bronchial hyperresponsiveness; asthma phenotypes; asthma severity; IgE; hierarchical cluster; inner-city asthma; rhinitis
Categories
Funding
- National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Department of Health and Human Services [HHSN272200900052C, HHSN272201000052I, 1UM1AI114271-01]
- National Center for Research Resources (NCRR)
- National Center for Advancing Translational Sciences (NCATS), NIH [NCRR/NIH UL1TR000451, UL1RR025780, UL1TR000075, NCATS/NIH UL1TR000154, UL1TR001082, UL1TR000077 04, UL1TR000040, UL1TR000150, UL1TR001105]
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Background: Children with asthma in low-income urban areas have high morbidity. Phenotypic analysis in these children is lacking, but may identify characteristics to inform successful tailored management approaches. Objective: We sought to identify distinct asthma phenotypes among inner-city children receiving guidelines-based management. Methods: Nine inner-city asthma consortium centers enrolled 717 children aged 6 to 17 years. Data were collected at baseline and prospectively every 2 months for 1 year. Participants' asthma and rhinitis were optimally managed by study physicians on the basis of guidelines. Cluster analysis using 50 baseline and 12 longitudinal variables was performed in 616 participants completing 4 or more follow-up visits. Results: Five clusters (designated A through E) were distinguished by indicators of asthma and rhinitis severity, pulmonary physiology, allergy (sensitization and total serum IgE), and allergic inflammation. In comparison to other clusters, cluster A was distinguished by lower allergy/inflammation, minimally symptomatic asthma and rhinitis, and normal pulmonary physiology. Cluster B had highly symptomatic asthma despite high step-level treatment, lower allergy and inflammation, and mildly altered pulmonary physiology. Cluster C had minimally symptomatic asthma and rhinitis, intermediate allergy and inflammation, and mildly impaired pulmonary physiology. Clusters D and E exhibited progressively higher asthma and rhinitis symptoms and allergy/inflammation. Cluster E had the most symptomatic asthma while receiving high step-level treatment and had the highest total serum IgE level (median, 733 kU/L), blood eosinophil count (median, 400 cells/mm(3)), and allergen sensitizations (15 of 22 tested). Conclusions: Allergy distinguishes asthma phenotypes in urban children. Severe asthma often coclusters with highly allergic children. However, a symptomatic phenotype with little allergy or allergic inflammation was identified.
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