In older adults with asthma, distinct phenotypes vary on key features that are more pronounced among the elderly, including comorbidities, fixed airway obstruction, and duration of asthma ≥40 years. Further work is required to determine the clinical and therapeutic implications for different asthma phenotypes in older adults.
Older adults with asthma and a greater desire for involvement in decision making have better asthma-related quality of life. Future studies with the intention to increase patient autonomy may help establish a causal relationship.
Multiple new and elusive causes of anaphylaxis have been described over the past 35 years. Further research is required to identify the epidemiology, pathophysiology, and clinical impact of these hidden causes. Although these culprits should be considered in the appropriate clinical scenarios, many remain exceedingly rare.
RATIONALE: Allergen immunotherapy (AIT) is effective in treating allergic disease, yet patient adherence is poor. We hypothesized increased adherence would occur with a modified rush protocol, defined as an accelerated one day build for the first two dilutions, followed by a conventional build to successfully reach maintenance dose. METHODS: Patients 12 years and older who began immunotherapy at Grand Rapids Allergy in 2014 were offered a modified rush or a conventional build protocol. Patients were retrospectively analyzed for adherence, defined as ordering a maintenance vial, and systemic reactions. RESULTS: There were 623 subjects, 392 in the conventional group and 231 in the rush group. There was no significant difference in age between the two groups (p50.212). Of the 392 subjects in the conventional group, 253 reached maintenance (64.5%). Of the 231 modified rush subjects, 195 reached maintenance (84.4%). There was a statistically significant difference (p<0.001) in the proportion of patients who reached maintenance dose between the two immunotherapy groups. As age increased, so did the likelihood of reaching maintenance dose (95% CI: 1.01-1.03). Safety data analyzing the systemic reaction rate of the modified rush group is pending. CONCLUSIONS: AIT with a modified rush protocol significantly improves adherence to reach a maintenance dose compared to patients with a pure conventional build. Maintenance dosing improves symptom control and allows patients to lengthen injections to monthly intervals, lessening the time commitment. Improved adherence may also decrease the medical complications of undertreated allergic rhinitis and the financial burden of allergic disease.
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