Benefits of Aeroallergen Testing on Oral Corticosteroid Bursts in Adults with Asthma.
Benefits of Aeroallergen Testing on Oral Corticosteroid Bursts in Adults with Asthma.
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气源性过敏原测试对成人哮喘患者口服皮质类固醇爆发的好处。
DOI：
10.1101/2024.01.29.24301962
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Himes,BlancaE
中科院分区：
文献类型：
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作者：
Gleeson,PatrickK;Morales,KnashawnH;Buckey,TimothyM;Fadugba,OlajumokeO;Apter,AndreaJ;Christie,JasonD;Himes,BlancaE
Groundaeroallergen测试可以改善持续性哮喘的精确护理，并被美国临床指南推荐。如何测试的好处不同人群的成年人哮喘，和重要性的测试方式，使用，没有完全understood. SAFETIVE我们试图评估是否收到空气过敏原测试与减少口服皮质类固醇（OCS）bursts. METHODS我们使用电子健康记录数据进行回顾性，在2017年1月1日至2022年6月30日期间在大型卫生系统接受吸入性皮质类固醇处方并接受过敏/免疫学访视的成人哮喘患者中开展的观察性队列研究。采用负二项回归模型评价接受吸入性过敏原检测的患者在首次访视后12个月内OCS爆发是否减少。我们还测量了排除慢性阻塞性肺疾病（COPD）和吸烟史患者后的获益差异，以及是否通过皮肤点刺或血清接受检测。在所有患者中，接受检测与爆发次数减少无关（发生率比（IRR）=0.83 vs无检测，p=0.059），但在无COPD的从不吸烟者中发生（417/844例检测，IRR=0.68，p=0.004）。接受皮肤检查与所有患者的爆发次数较少相关（418/1，383例受试者，IRR=0.77，p=0.02）和不伴COPD的从不吸烟者（283/844例受试者，IRR=0.59 vs无检测，p=0.001）。结论在过敏/免疫学护理背景下，与指南一致的空气过敏原检测与现实生活中的临床益处相关，成人哮喘患者的不同队列。这种获益因患者合并症和检测方式而异。
BACKGROUNDAeroallergen testing can improve precision care for persistent asthma and is recommended by the U.S. clinical guidelines. How testing benefits diverse populations of adults with asthma, and the importance of the testing modality used, are not fully understood.OBJECTIVEWe sought to evaluate whether receipt of aeroallergen testing was associated with a reduction in oral corticosteroid (OCS) bursts.METHODSWe used electronic health record data to conduct a retrospective, observational cohort study of adults with asthma who were prescribed an inhaled corticosteroid and had an Allergy/Immunology visit in a large health system between 1/1/2017-6/30/2022. Negative binomial regression models were used to evaluate whether OCS bursts in the 12-month period after an initial visit were reduced for patients who received aeroallergen testing. We also measured differences in benefit after excluding patients with chronic obstructive pulmonary disease (COPD) and smoking histories, and whether testing receipt was via skin prick or serum.RESULTS668/1,383 (48.3%) patients received testing. Receipt of testing was not associated with fewer bursts in all patients (incidence rate ratio (IRR)=0.83 versus no testing, p=0.059), but it was among never smokers without COPD (417/844 tested, IRR=0.68, p=0.004). The receipt ofskintesting was associated with fewer bursts in all patients (418/1,383 tested, IRR=0.77, p=0.02) and among never smokers without COPD (283/844 tested, IRR=0.59 versus no testing, p=0.001).CONCLUSIONGuideline-concordant aeroallergen testing in the context of Allergy/Immunology care was associated with clinical benefit in a real-life, diverse cohort of adults with asthma. This benefit varied according to patient comorbidities and the testing modality.