Outdoor Allergies are Associated with Increased Oral Corticosteroid Use in Children with Allergic Asthma in New York City: A Single-Center Retrospective Study

Abstract

Sensitization and exposure to environmental allergens is well known to be related to asthma morbidity; however, individual populations may vary with respect to specific risk factors associated with exacerbations. Among children with asthma in our urban community practices, we sought to better characterize children with the allergic asthma phenotype to identify allergic predictors of poor asthma outcomes. This is a single-center retrospective chart review using electronic health records of 264 children (3 to 21 years) with asthma in New York City, with outpatient encounters at NYPH-Weill Cornell Medicine from January 2015 to April 2019. Descriptive statistics were used to define allergic (N = 213) and nonallergic (N = 54) groups. Logistic regression models were used to assess the association between allergy status and asthma severity. Among children with allergic asthma, 48.4% had both indoor and outdoor allergies. Subjects with indoor and outdoor allergies had increased odds (ORunadj 3.65; 95% CI 1.36-9.76, p=0.010) of having persistent asthma, compared to having indoor allergies alone. Compared to the non-allergic group, subjects with outdoor allergies had increased odds (ORunadj 7.29; 95% CI 1.44-37.01, p=0.017) of asthma exacerbations requiring oral steroids. There were no associations between the degree of sensitization and asthma exacerbations, severity or control. In this cohort, outdoor allergies is an important risk factor for asthma exacerbations over degree of sensitization, or presence of indoor allergies. In addition to avoidance measures, this higher risk subset of patients may benefit from aggressive medication regimens including consideration of targeted allergen immunotherapy, to improve asthma outcomes.