Marcia Frellick

October 31, 2017

BOSTON — A family history of asthma and a patient's own history of atopic dermatitis might help predict the "severity" of a hospital stay, according to a small study.

That information could help identify which children are at risk and inform treatment, lead researcher Mona Liu, MD, a pediatric resident at Children's Hospital of Los Angeles, told Medscape Medical News.

It might also encourage more aggressive treatment or earlier tailoring of management to keep children from entering the hospital in the first place, she said here at the American College of Allergy, Asthma & Immunology 2017 Annual Scientific Meeting.

A more severe stay can include admission to an intensive care unit, a longer stay, more hours of continuous albuterol use, and more oxygen use.

Dr Liu and her colleagues examined the relation between medical history, allergic reactions, and a child's hospital experience after an asthma attack.

Medical History

The study involved 39 children 1 to 17 years of age who were admitted to the Children's Hospital of Los Angeles because of asthma.

Average age in the cohort was 7 years, and 56% of the children were Hispanic.

The researchers looked at factors such as the medications used for control and the family, medical, atopic, and environmental history.

They tested the children for allergies to grass, dust, cockroach, dog, cat, mold, ragweed, and other common allergens, but found no significant link between the number of allergies and the level of treatment required in the hospital.

A family history of asthma was more common in patients admitted to the ICU than in those just admitted to the hospital (62% vs 14%; = .04).

In addition, a history of atopic dermatitis was linked with a longer hospital stay (= .05) and more continuous albuterol (= .017).

"For patients without a history of eczema, the median length of stay was 3 days, and those with a history of eczema, the median length of stay was 4 days," Dr Liu reported.

This study suggests risk factors that may identify children with more severe asthma hospitalization.

The association between eczema and asthma in this study is interesting, said Luz Fonacier, MD, head of allergy and training program director at the NYU Winthrop Hospital in Mineola, New York. Atopic dermatitis is a systemic disease, and inflammation involves multiple organ systems, she pointed out.

"This study suggests risk factors that may identify children with more severe asthma hospitalization," she told Medscape Medical News.

If these findings are confirmed in a larger study, physicians might be able to identify kids on admission, or even in the emergency department, as having significant eczema, and therefore at risk for a longer hospital stay, said Brian Kelly, MD, from Boys Town National Research Hospital in Omaha, Nebraska.

"We could monitor them earlier and maybe identify decompensation earlier," he told Medscape Medical News.

Given that family history of asthma was also shown to be predictive of a longer ICU stay, those questions must be asked, he said.

Dr Liu said her team is recruiting patients for a larger study to confirm their findings.

The study was supported by Sunair Children's Foundation. Dr Liu, Dr Fonacier, and Dr Kelly have disclosed no relevant financial relationships.

American College of Allergy, Asthma & Immunology (ACAAI) 2017 Annual Scientific Meeting: Abstract 5204. Presented October 29, 2017.

Follow Medscape on Twitter @Medscape and Marcia Frellick @mfrellick

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