• William J Sheehan, Rebecca Z Krouse, Agustin Calatroni, Peter J Gergen, James E Gern, Michelle A Gill, Rebecca S Gruchalla, Gurjit K Khurana Hershey, Meyer Kattan, Carolyn M Kercsmar, Carin I Lamm, Frederic F Little, Melanie M Makhija, Daniel A Searing, Edward Zoratti, William W Busse, Stephen J Teach, and NIAID-sponsored Inner-City Asthma Consortium.
• Children's National Hospital and George Washington University School of Medicine and Health Sciences, Washington, DC. Electronic address: wsheehan@childrensnational.org.
• J Allergy Clin Immunol Pract. 2020 Oct 1; 8 (9): 3021-3028.e2.

BackgroundPerennial aeroallergen sensitization is associated with greater asthma morbidity and is required for treatment with omalizumab.ObjectiveTo investigate the predictive relationship between the number of aeroallergen sensitizations, total serum IgE, and serum eosinophil count, and response to omalizumab in children and adolescents with asthma treated during the fall season.MethodsThis analysis includes inner-city patients with persistent asthma and recent exacerbations aged 6-20 years comprising the placebo- and omalizumab-treated groups in 2 completed randomized clinical trials, the Inner-City Anti-IgE Therapy for Asthma study and the Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations study. Logistic regression modeled the relationship between greater degrees of markers of allergic inflammation and the primary outcome of fall season asthma exacerbations.ResultsThe analysis included 761 participants who were 62% male and 59% African American with a median age of 10 years. Fall asthma exacerbations were significantly higher in children with greater numbers of aeroallergen-specific sensitizations in the placebo group (odds ratio [OR], 1.33; 95% confidence interval [CI], 1.11-1.60; P < .01), but not in the omalizumab-treated children (OR, 1.08; 95% CI, 0.91-1.28; P = .37), indicating a significant differential effect (P < .01). Likewise, there was a differential effect of omalizumab treatment in children with greater baseline total serum IgE levels (P < .01) or greater baseline serum eosinophil counts (P < .01). Multiple aeroallergen sensitization was the best predictor of response to omalizumab; treated participants sensitized to ≥4 different groups of aeroallergens had a 51% reduction in the odds of a fall exacerbation (OR, 0.49; 95% CI, 0.30-0.81; P < .01).ConclusionsIn preventing fall season asthma exacerbations, treatment with omalizumab was most beneficial in children with a greater degree of allergic inflammation.Copyright © 2020 American Academy of Allergy, Asthma & Immunology. All rights reserved.

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