Pediatric Asthma Patients Research Articles

Evaluation of the Arabic version of the Asthma Trigger Inventory among asthmatic pediatric patients in Saudi Arabia

Background Asthma Trigger Inventory (ATI) is available in English, German, and Spanish languages, however, a version in Arabic language specifically tailored for identifying asthma triggers within Saudi Arabia has been missing. Objectives To assess the reliability and validity of the adapted Arabic ATI among parents of asthmatic children in Saudi Arabia. Methods A cross-cultural adaptation of the ATI was conducted, adding seven region-specific triggers to reflect cultural and environmental factors. The Pediatric Asthma Quality of Life Questionnaire (PACQLQ) was used to assess quality of life. Construct validity of the Arabic ATI was evaluated via exploratory factor analysis (EFA), and reliability was measured with Cronbach’s alpha. Results EFA yielded a KMO of 0.634 and a significant Bartlett’s Test (χ2 = 10,005.076, p < 0.001). Six trigger subscales showed high reliability (α > 0.90), though Middle Eastern triggers had lower internal consistency (α = -0.11). Physical and psychological triggers correlated significantly with poorer quality of life (exercise: r = -0.662, p < 0.001; psychological: r = -0.307, p < 0.001). Air pollution and Middle Eastern triggers correlated positively with quality of life (r = 0.222, p < 0.001 and r = 0.245, p < 0.001). Conclusion The Arabic version of the ATI exhibited robust reliability and validity when administered to parents of asthmatic children in Saudi Arabia. Additional research is warranted to further validate its applicability across various Arabic-speaking populations.

Characterizing Non-T2 Asthma: Key Pathways and Molecular Implications Indicative of Attenuated Th2 Response.

Non-Type 2 (non-T2) asthma is characterized by a lack of allergic sensitization and normal to low total IgE levels. We aimed to explore molecular mechanisms and pathways differentiating non-T2 from T2-high pediatric asthma. We analyzed peripheral blood RNA samples from 11 non-T2 and 17 T2-high pediatric asthma patients using bulk RNA sequencing. Differentially expressed genes (DEGs) were identified, followed by Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses, and Protein-Protein Interaction (PPI) network construction. Gene Set Enrichment Analysis (GSEA) and Ingenuity Pathway Analysis (IPA) were employed to explore significance of these DEGs. We utilized independent public datasets GSE145505 to validate our findings. We investigated Th cytokine profiles in an independent cohort of pediatric patients with non-T2 asthma (n = 38) and T2-high asthma (n = 64). We demonstrated that the total serum IgE levels of children with non-T2 asthma (128.4 ± 159.5IU/mL) was significantly lower than that of those with T2-high asthma (405.8 ± 252.1IU/mL). Our analysis revealed 136 DEGs distinguishing non-T2 from T2-high asthma. IPA identified predicted inhibition of IgE-FcεRI signaling pathways in non-T2 asthma. Our DEG data showed the expression of IGHV4-39, IGLV1-40, IGLV1-47, IGLV1-44, IGHV1-69, IGLV6-57, IGLV3-19, IGLV3-1, and IGLC7 were downregulated in our non-T2 asthma patient. The non-T2 group exhibited significantly higher concentrations of IL-2, IFN-γ, IL-6, and IL-17A compared to the T2-high group. Our integrated analysis differentiated non-T2 from T2-high asthma by revealing downregulation of specific immunoglobulin genes influencing FcεRI signaling, elevated Th1 cytokines and Th17 cytokines might affect IgE associated sensitization and alter Th2 allergic response.

Effect of continuous inhaled corticosteroids on glycated hemoglobin in asthmatic children: a pilot study

BackgroundAsthma is a prevalent chronic disease with significant impact on patients, families, and communities. Inhaled corticosteroids (ICS) are the mainstay of treatment for persistent and uncontrolled asthma. However, concerns remain about the potential adverse effects of ICS, including HbA1c level. This study aims to evaluate the influence of ICS on Hemoglobin A1c (HbA1c) levels in children with bronchial asthma.MethodsThis prospective cohort study included 48 pediatric asthma patients aged 2 to 15 years who had been using ICS for at least 6 months. Comprehensive clinical assessments and measurements of HbA1c levels were conducted at the start of recruitment and after 6 months of ICS use. The types and doses of ICS used followed the guidelines provided by the Global Initiative for Asthma (GINA).ResultsThe initial HbA1c levels ranged from 4.46 to 6.11, with a mean of 5.32 ± 0.35. Three patients (6.3%) had persistent prediabetes status after 6 months. There was no significant relationship between glycemic status and the characteristics of ICS. The duration of ICS therapy and the doses used did not significantly affect HbA1c levels. A weak positive correlation was observed between initial and subsequent HbA1c levels.ConclusionThe study found no significant difference in HbA1c levels among asthmatic children using ICS after six months of treatment. Additionally, there was no significant difference in HbA1c levels between patients using different types of ICS. Regular monitoring of HbA1c levels is recommended, particularly for children on high doses or prolonged use of inhaled Fluticasone.

Fatigue in severe pediatric asthma patients: Results of the PANDA study.

Fatigue is a commonly reported clinical symptom, yet research on fatigue in children with severe asthma is missing. We aimed to explore the extent of fatigue in severe pediatric asthma and identify associated factors. This study was conducted within the Pediatric Asthma Non-Invasive Diagnostic Approaches (PANDA), an observational cohort of 6- to 17-year-old Dutch children with severe asthma. The Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (PedsQL™-MFS) was used to measure self-reported fatigue. Fatigue levels were compared with a general pediatric Dutch population using linear regression, and quantifying the prevalence of "fatigued" (-2 < Standard deviations [SD] ≤ -1) and "severely fatigued" (SD ≤ -2) children. Secondly, we performed linear regression analyses to explore whether fatigue levels were independently associated with asthma attacks, comorbidities, medication, pulmonary function, symptom control, and asthma-related quality of life (QoL). Severe pediatric asthma patients (n = 78, mean age 11.8 ± 3.1 years) reported significantly more fatigue than Dutch peers (n = 328, mean age 11.8 ± 3.2 years) mean difference in z-score: -0.68; 95%CI -0.96, -0.40. In the severe asthma group, 28.2% scored as "fatigued" and 15.4% as "severely fatigued," compared with 14.0% and 3.4% in the general population. In pediatric asthma patients, asthma-related QoL (β = 0.77, p < .01, ΔR2 = .43), symptom control (β = 0.56, p < .01, ΔR2 = .24) and a dysfunctional breathing pattern (β = -0.36, p < .01, ΔR2 = .12) were most strongly associated with fatigue scores. Fatigue is a common symptom in children with severe asthma and is associated with multiple clinical factors and patient-reported outcomes. It should be considered as an important treatment target.

412EMF Enrolling Pediatric Asthma Patients for an Environmental Precision Medicine Research: A Feasibility Study

412EMF Enrolling Pediatric Asthma Patients for an Environmental Precision Medicine Research: A Feasibility Study

Evaluation of a novel pediatric asthma inhalation drug delivery device: a focus on patient accessibility, ease of use, dosage feedback, and future directions

Objective Pediatric asthma management faces challenges in medication delivery through oral inhalation devices. While dry powder inhalers (DPIs) are increasingly prescribed to children, many do not receive their prescribed dosage due to insufficient inspiratory flow. This study investigates the utilization of metered-dose inhalers (MDIs) and DPIs among pediatric patients with asthma, focusing on medication delivery challenges. Methods Two survey cohorts comprising a total of 42 caregivers of patients with asthma were conducted. Modifications in the second cohort addressed neutral Likert scale responses to obtain more nuanced feedback. Results Caregivers expressed concerns about uncertainties in their child’s ability to use both MDIs and DPIs and challenges in ensuring proper dosage. Notably, 42% of caregivers in the second cohort rated their child’s inhaler usage as unable, indicating a significant worry about the efficacy of current delivery methods. Additionally, 50% of caregivers across both cohorts expressed uncertainties about their child receiving the full medication dosage. In response to identified challenges with DPIs, an adaptor device emerged as a potential solution, with caregivers exhibiting positive perceptions post-exposure. Features prioritized for the device include ease of use and assurance of dose delivery. Conclusions The study highlights caregiver preferences and the need for innovations to ensure effective medication delivery for pediatric asthma patients. A DPI adaptor device shows promise in addressing technical issues and alleviating caregiver concerns, ultimately contributing to more effective asthma management. Future research should refine these devices based on caregiver feedback to meet the evolving needs of the pediatric asthma population.

The short-term association between environmental variables and daily pediatric asthma patient visits in Hangzhou, China: A time-series study

BackgroundTo date, a large number of studies have shown correlations between environmental variables and pediatric asthma in short-term lag time. However, their results are inconsistent. Therefore, we aimed to evaluate the short-term impact of environmental variables on daily pediatric asthma patients’ visits (DPAPV) in Hangzhou, China, and find the most important risk factor. MethodsGeneralized additive distribution lag non-linear model (GAM-DLNM) was applied to explore the effect of environmental variables on DPAPV in single- and multi-variable models in Hangzhou, China from 2014 to 2021. Then, risk factors of pediatric asthma were selected (p < 0.05 both in single- and multi-variable models) and used weighted quantile sum (WQS) regression model to evaluate their relative importance. ResultsThere were 313,296 pediatric asthma patient records between 2014 and 2021. Both in single- and multi-variable models, PM2.5, PM10, and NO2 exhibited significant positive correlations in short-term lag time and these correlations reached their maximum in lag day 2 (RR = 1.00, 95%CI:1.00 to 1.01), lag day 2 (RR = 1.00, 95%CI:1.00 to 1.01), and lag day 3 (RR = 1.04, 95%CI:1.02 to1.05), respectively. The WQS index showed that NO2 had the greatest relative importance (weight over 70 %). The relative importance of NO2 increased with time passing. Males were more susceptible to the adverse effects of NO2. ConclusionPM2.5, PM10, and NO2 had significant adverse effects on pediatric asthma. Among them, NO2 presented the greatest and most important adverse effect on the disease. Therefore, parents could give priority to paying attention to NO2 to control children's asthma.

Effect of Long-Term Inhaled Corticosteroid Therapy on Metabolic And Anthropometric Parameters in Pediatric Patients with Asthma

Background: The long-term impact of inhaled corticosteroids (ICSs) metabolic parameters of asthmatic children is still uncertain. Objective: This study aimed to evaluate the effects of long-term use of ICSs on metabolic and anthropometric measures in children with asthma in Iran. Methods: This case-control study was conducted among 200 pediatric asthmatic patients who were referred to Abuzar Hospital (Ahvaz, Iran) during nine months. Demographic and clinical data of the patients were recorded. The participants were categorized into two groups: Group 1 (n = 100) comprising children with moderate to severe asthma, and Group 2 (n = 100) consisting of those with mild asthma. Results: The average age of 200 patients was 8.1 ± 2.9 years. The majority of them were male. The prevalence of wasting, stunting, obesity, and overweight was higher among Group 1 compared to Group 2 (p &lt; 0.05). Patients in Group 1 had significantly higher levels of calcium, vitamin D, lipids, and glycemic parameters than those in Group 2 (p &lt; 0.05). In addition, the duration of ICS use was notably longer in Group 1 (p &lt; 0.05). Conclusion: Children with moderate and severe asthma had significantly elevated lipid and glycemic parameters, as well as a higher prevalence of wasting, stunting, obesity, and overweight compared to patients with mild asthma. Further studies involving larger sample sizes and longer durations are necessary to confirm these findings.

Supraventricular tachycardia diagnosis in asthma patients is associated with adverse health outcomes.

Supraventricular tachycardia (SVT) can occur during treatment of an acute asthma exacerbation. There are, however, no data on the long-term outcomes of children who are diagnosed with both asthma and SVT. This study aims to analyze the impact of SVT in asthmatic children on mortality and/or cardiac arrest, hypothesizing asthmatic subjects with SVT have increased mortality and/or cardiac arrest compared to asthmatic subject with no-SVT. This was a retrospective cohort study, utilizing the TriNetX© electronic health record (EHR) database that included asthmatic subjects 2-18 years of age. The study population was divided into two groups (subjects with SVT diagnosis and no-SVT diagnosis). Data related to demographics, diagnostic, procedural, and medication codes were collected. The primary outcome was any death and/or cardiac arrest in a patient after the first asthma diagnosis date. This study included 91,066 asthmatic subjects (244 [0.27%] with SVT and 90,822 [99.73%] with no-SVT). Multivariable logistic regression analysis demonstrated that after controlling for demographic and clinical features, the odds of all-cause death and/or cardiac arrest after the first reported asthma exacerbation was significantly higher in asthmatic children with SVT compared to no-SVT (odds ratio [OR]: 4.30, confidence interval [CI]: 2.50-7.39, p < .001). Our large nationwide EHR study suggests that asthmatic pediatric patients with documented SVT diagnosis at any point in their EHR may be at increased risk of adverse health outcomes compared to no-SVT. Further studies are needed to determine the factors contributing to the increased risk of mortality and/or cardiac arrest in children with asthma and SVT.

Comparison and review of international guidelines for treating asthma in children.

Asthma, the most common chronic disease, is characterized by airway inflammation and airflow obstruction. The World Health Organization estimates that approximately 300 million people worldwide have asthma, 30% of whom are pediatric patients. Asthma is a major cause of morbidity that can lead to hospitalization or death in severe pediatric cases. Therefore, it is necessary to provide children with objective and reliable treatment according to consistent guidelines. Several institutes, such as the Global Institute for Asthma, National Heart, Lung, and Blood Institute, British Thoracic Society, Japanese Society of Pediatric Allergy and Clinical Immunology, and Korean Academy of Asthma, Allergy, and Clinical Immunology have published and revised asthma guidelines. However, since recommendations differ among them, confusion persists regarding drug therapy for pediatric asthma patients. Additionally, some guidelines have changed significantly in recent years. This review investigated the latest changes in each guideline, compared and analyzed the recommendations, and identified the international trends in pediatric asthma drug therapy. The findings of this review may aid determinations of the future direction of the Korean guidelines for childhood asthma.

Role of Exhaled Nitric Oxide in Management of Asthma in Pediatric Patients: A Systematic Review

Background: Fractional exhaled nitric oxide (FeNO) has emerged as a potential tool for managing asthma in children, but its precise role remains under investigation. Objectives: This systematic review aims to comprehensively evaluate the current research on FeNO's utility in managing pediatric asthma. Methods: We conducted a systematic search of electronic databases like PubMed, MEDLINE, Science Direct, and Scopus. Two independent reviewers screened and extracted data from eligible studies. Results: Sixteen studies including 4612 participants in total and more than half of them 2558 (55.5%) were males—were included in our data. Intermediate FeNO levels had a higher yearly hospitalization rate than those with low or high FeNO levels. FeNO can be a predictive marker as one study found that FeNO levels of more than 35 ppb have the highest risk of developing respiratory disease in the future. Regarding the benefits of FeNO-guided therapy, the use of FENO in conjunction with GINA guidelines for ICS titration can help reduce daily ICS doses and treatment costs. FeNO was found reliable as an asthma biomarker only in children with concomitant aeroallergen sensitivity. Conclusion: The evidence for the effectiveness of FeNO-guided asthma care in children is critical. The effect of FeNO-guided treatment on pharmaceutical use is unclear. Any benefits in illness control must be balanced against the risk of increased drug use, particularly ICS, as higher rates were frequently observed in children with FeNO-guided monitoring. There is an obvious need for larger, longer-term research to address these problems before making firm recommendations for routine therapeutic use.

The complicated relationship between asthma and swimming

Introduction: Apart from pharmacological treatment, non-pharmacological strategies including physical activity play a significant role in the management of asthma. The aim of this paper is to examine various topics related to swimming and asthma. They include the detailed effect of swimming on asthma control,the potential role of swimming in early childhood asthma development, exercise induced asthma in swimmers as well as the relationship between asthma and cold water swimming. Review methods: This article is based on the literature found in the PubMed Database from the period of 1971-2024 with the use of keywords such as “asthma”, “swimming”, “cold water swimming”, “exercise induced asthma”, “childhood asthma” Description of the state of knowledge: Swimming is a safe form of physical activity for asthma patients.Swimming training enhances aerobic capacity, reduces exercise-induced bronchoconstriction and improves lung function in both pediatric and adult patients. However, there is a concern regarding indoor swimming pools that chlorine can potentially induce airway inflammation. There is research suggesting that early life swimming pool exposure may contribute to the asthma development in atopic children. There is some premise to the thought that cold water swimming may help alleviate asthma symptoms, but it also carries many risks.Swimming is a major cause of exercise induced asthma in professional athletes. Conclusions: Alongside appropriate pharmacological treatment, swimming is a valuable strategy in asthma management in both pediatric and adult asthma patients. The risks of chlorinating pools are still not known to outweigh the benefits of swimming for asthmatics. Further research should be carried out on safety of early swimming in atopic children. Cold water swimming should also be evaluated in terms of safety and potential benefits for asthma patients.

A Review of the Latest Guidelines for Diagnosing and Managing Asthma in Children in the United States and Canada.

Globally, asthma remains the most widespread chronic respiratory condition in children, with a larger proportion of children being affected by the condition. Regardless of the higher prevalence rates, the outcomes of pediatric asthma have remained inadequate, even as there are numerous preventable deaths (approximately 300 children in the United States and 250 children in Canada, annually). The characteristic symptoms of pediatric asthma include wheezing, cough, and shortness of breath that are characteristically triggered by several potential stimuli. However, several diagnostic challenges exist and have resulted in either overdiagnosis or underdiagnosis, making pediatric asthma diagnosis and management problematic. Effective management of asthma in children entails a holistic approach that encompasses non-pharmacological and pharmacological management, alongside self-management and educational aspects. Working with pediatric asthma patients and their families/caregivers is vital to promoting and realizing better asthma diagnosis and management outcomes. Educational guidelines regarding the best ways for effective treatment, avoidance of triggers, modifiable risk factors, and the actions that should be taken during chronic asthma attacks through individualized action plans are vital. Thus, the objective of this systematic review is to provide an overview of the latest guidelines on pediatric asthma diagnosis and management. In this regard, this review presents several similarities in existing pediatric asthma diagnosis and management guidelines in the United States and Canada. For instance, most guidelines and studies reviewed have proposed the use of objective tests for confirmation of asthma diagnosis, particularly in symptomatic individuals. The peak flow variability measurement, bronchodilator reversibility testing, and spirometry have also been proposed by the guidelines and studies, even as the recommendations regarding the timing and hierarchy of the objective test substantially vary between the guidelines and studies. We hope that the present review will be helpful to physicians and healthcare service providers working within pediatric health contexts.

Clinical efficacy and safety study of Loratadine combined with glucocorticoid nasal spray in the treatment of pediatric bronchial asthma with seasonal allergic rhinitis

Objective To investigate the clinical efficacy and safety of Loratadine combined with Glucocorticoid nasal spray in the treatment of pediatric bronchial asthma with seasonal allergic rhinitis. Methods A total of 100 pediatric patients with moderate to severe bronchial asthma and seasonal allergic rhinitis admitted to our hospital between January 2020 and January 2023 were included in this study. All patients met the complete inclusion and exclusion criteria. Based on different treatment interventions, they were divided into the control group (n = 50) and the observation group (n = 50). Patients in the control group received treatment with glucocorticoid nasal spray, while patients in the observation group received combined intervention with Loratadine in addition to the treatment received by the control group. The clinical treatment outcomes, incidence of adverse reactions, as well as the scores of nasal symptoms, asthma control, and peak expiratory flow rates at different treatment time points (baseline, T1: 30 days after treatment, T2: 60 days after treatment, T3: 90 days after treatment) were compared between the two groups. The combined treatment of Loratadine with Glucocorticoid nasal spray demonstrates significant clinical efficacy in the treatment of pediatric bronchial asthma with seasonal allergic rhinitis. It further promotes the recovery of peak expiratory flow rates, improves symptoms of rhinitis and asthma in pediatric patients. Importantly, the application of this combined treatment does not increase the risk of adverse reactions in pediatric patients, indicating its high safety profile. This treatment approach is worthy of clinical application and further promotion.

Оптимизация контроля заболевания у ребенка с бронхиальной астмой

The achievement of good control of bronchial asthma in pediatric patients is the cornerstone of the treatment of this disease. The analysis of certain factors of partial and uncontrolled course of bronchial asthma in children is presented. As a result of the analysis, it was revealed that the reason that prevents the achievement of control in bronchial asthma in children is food sensitization, as well as a violation of the technique of inhalation of drugs. The analysis of the practical errors presented in the article will contribute to timely and competent therapy, and in general – an improvement in the quality of life of the patient.

EE446 Economic Burden of Mild or Moderate Asthma in Pediatric Patients from the Perspective of Public Health Institutions in Mexico

EE446 Economic Burden of Mild or Moderate Asthma in Pediatric Patients from the Perspective of Public Health Institutions in Mexico

Asthma control associated with anxiety and depression in asthmatic children following post-acute COVID-19.

Poor asthma control may adversely affect mental health. Our study investigates the correlation between inadequate asthma control, exhaled nitric oxide (FENO) levels, and anxiety and depression among pediatric asthma patients with COVID-19. This prospective case-control study enrolled 520 asthmatic children (8-15 years), including 336 patients diagnosed with COVID-19 after rapid antigen testing at home and 184 age-matched asthmatic patients without COVID-19 infection. FENO and spirometry were performed 1 month after COVID-19 infection. Scores for Child Anxiety-Related Disorders (SCARED) and depression screen derived from Patient Health Questionnaire-9 (PHQ-9) to assess their mental health status. Childhood asthma control test (C-ACT), FENO levels, and spirometry were correlated with the SCARED and PHQ-9 questionnaires. SCARED subscales, including generalized anxiety disorder, social anxiety disorder, school avoidance, and depression scores from PHQ-9, exhibited a significant increase in asthmatic patients diagnosed with COVID-19 (p < .05). Among asthmatic children with SARS-CoV-2 infection, the poor asthma control group exhibited the highest SCARED and PHQ-9 measurements (p < .01). Multiple linear regression analysis indicated that reduced C-ACT scores and elevated FENO levels in asthmatic children with COVID-19 were significant risk factors for both anxiety and depression scores (p < .05). Lower C-ACT scales were associated with high scores of SCARED (r = -0.471) and PHQ-9 (r = -0.329) in asthmatic children (p < .001). The current study emphasizes the need for healthcare professionals to closely monitor asthma control in asthmatic children to prevent heightened risks of depression and anxiety during the ongoing COVID-19 pandemic.

Once-daily fluticasone furoate/vilanterol vs once-daily fluticasone furoate in patients with asthma aged 5 to 17 years

BackgroundLimited data exist comparing inhaled corticosteroid (ICS) plus adjunctive therapy vs ICS alone in pediatric asthma patients. ObjectiveTo evaluate the efficacy and safety of fluticasone furoate/vilanterol (FF/VI) vs FF in children and adolescents with asthma. MethodsThis phase 3, randomized, double-blind, multicenter study (NCT03248128) included participants aged 5 to 17 years with six months or more asthma history uncontrolled on ICS monotherapy. Participants received 4-week open-label fluticasone propionate (100 µg) twice daily before 1:1 randomization to 24-week double-blind FF (50 µg:100 µg) or FF/VI (50/25 µg:100/25 µg) once daily. Two populations with different primary endpoints were analyzed to meet United States (week 12 weighted mean forced expiratory volume in 1 second [FEV1; 0-4 hours]; participants aged 5–17 years) and European (change from baseline predose morning peak expiratory flow [ΔAM PEF] averaged over weeks 1-12; participants aged 5-11 years) regulatory requirements. ResultsOverall, 902 participants, including 673 children aged 5 to 11 years, were randomized and treated. In participants aged 5 to 17, week 12 weighted mean FEV1 (0-4 hours) was greater with FF/VI vs FF (difference: 0.083 L; P < .001). In participants aged 5 to 11, ΔAM PEF over weeks 1 to 12 showed numerical improvement with FF/VI vs FF but was not statistically significant (difference: 3.2 L/min; P = .228). No drug-related serious adverse events or deaths were reported. ConclusionFF/VI significantly improved weighted mean FEV1 (0-4 hours; participants aged 5-17 years), but not ΔAM PEF (participants aged 5-11 years) vs FF. No new safety concerns were apparent. Trial RegistrationClinicalTrials.gov Identifier: NCT03248128.

IMMUNOGLOBULIN E IN PEDIATRIC ASTHMA: ADVANCES IN UNDERSTANDING AND MANAGEMENT

Asthma, a pervasive chronic inflammatory ailment of the respiratory system, remains a global health conundrum. The Global Burden of Disease Study (GBD) of 2019 underscores its widespread impact, revealing that asthma afflicts 262 million individuals worldwide, translating into an age-standardized prevalence of 3,416 per 100,000 population. The incidence among children is particularly alarming, with nearly 14% of the global pediatric population diagnosed with the condition. This statistic positions asthma as the foremost chronic respiratory disease among children, a trend that is on the rise, especially across Asia and Europe, as evidenced by the International Study of Asthma and Allergies in Childhood (ISAAC). Characterized by variable airflow limitation, bronchial hyperresponsiveness, excessive mucus production, and airway inflammation leading to airway constriction, asthma’s multifaceted nature complicates its management. In the realm of immunology, Immunoglobulin E (IgE) has been identified as a pivotal player. Recognized officially as the fifth class of serum immunoglobulins during the 1968 WHO International Reference Center for Immunoglobulins conference in Lausanne, IgE’s crucial role in the pathophysiology of asthma has been rigorously studied. Serum IgE levels, both total and specific, have been proven instrumental in the diagnosis, treatment, and prevention of pediatric asthma. The landmark approval of Omalizumab by the US Food and Drug Administration in 2003 heralded a new era in the biologic management of asthma, targeting children aged six and above. This was followed by the development of Ligelizumab and Quilizumab, innovative anti-IgE medications currently under investigation for their potential to alleviate symptoms and decelerate the disease’s progression. The integration of Allergy Immunotherapy (AIT) alongside monoclonal antibody therapies like Omalizumab, Ligelizumab, and Quilizumab signifies a monumental shift toward personalized medicine in asthma care. These advances promise not only to ameliorate the quality of life for pediatric asthma patients but also to redefine the landscape of asthma management. Nonetheless, the quest for enhanced treatment modalities for young asthmatics necessitates further in-depth research. The burgeoning field of anti-IgE therapy, in concert with AIT, is poised to set new benchmarks in pediatric asthma management, steering us towards a future where asthma’s grip on children’s health is significantly loosened.

Exploring TSLP and IL-33 Serum Levels and Genetic Variants: Unveiling Their Limited Potential as Biomarkers for Mild Asthma in Children.

As the burden of mild asthma is not well understood, the significance of expanding research in the group of patients with mild asthma is emphasized. Thymic stromal lymphopoietin (TSLP) and interleukin 33 (IL-33) are involved in the pathogenesis of atopy and the immune response to inhaled environmental insults, such as allergens, in asthmatic patients. Objectives: The objective of this study was to explore the correlation between specific polymorphisms within the genes encoding TSLP and IL-33, as well as the concentrations of TSLP and IL-33 in the serum, and the occurrence of pediatric mild asthma. Methods: The analysis encompassed 52 pediatric patients diagnosed with mild bronchial asthma, including both atopic and non-atopic cases, and a control group of 26 non-asthmatic children. Recruitment was conducted through a comprehensive questionnaire. Parameters such as allergic sensitization, serum levels of circulating TSLP and IL-33, and the identification of single-nucleotide polymorphisms in TSLP (rs11466750 and rs2289277) and IL-33 (rs992969 and rs1888909) were assessed for all participants. Results: Significantly lower mean serum TSLP concentrations were observed in asthmatic subjects compared to the control group, with atopic asthma patients showing even lower TSLP levels than non-atopic counterparts. No significant differences were found in mean serum IL-33 concentrations between the two groups. Considering the allele model, for both tested SNPs of IL-33, we observed that patients with asthma, atopic asthma, and atopy statistically less frequently possess the risk allele. Conclusions: Our study findings suggest that IL-33 and TSLP do not serve as ideal biomarkers for mild asthma in children. Their effectiveness as biomarkers might be more relevant for assessing disease severity rather than identifying asthma in pediatric patients. Further research focusing on the association between TSLP and IL-33 gene polymorphisms and asthma is expected to significantly advance disease management.