The Added Burden of Allergen Sensitization Among Children with Severe or Poorly Controlled Asthma

BACKGROUND: Allergen sensitization (AS) may negatively affect asthma outcomes in children with severe or poorly controlled (SPC) asthma. OBJECTIVES: To examine the impact of AS on asthma exacerbations, health care use, and costs among children with SPC asthma in private and public insurance settings. METHODS: This retrospective study analyzed children with SPC asthma aged 6 to 11 years from the MarketScan Commercial (private insurance) and Medicaid databases. Selection of children with SPC asthma was based on medical claims and asthma medication prescription claims. AS status was based on diagnoses of extrinsic asthma and allergic conditions. Children were followed for at least 12 months. Outcomes included asthma exacerbations, days with oral corticosteroids (OCS), and asthma-related health care use and costs. Adjusted generalized linear models were fit to compare outcomes in children with versus those without AS. RESULTS: Among children with SPC asthma, 34% had AS (private insurance: N = 11,448; Medicaid: N = 10,800), 20% did not have AS (private insurance: N = 7744; Medicaid: N = 6535), and, in the remainder, AS status could not be determined. Claims data were available for >= 3 years on average. Children with AS had significantly higher adjusted rates of asthma exacerbations during follow-up than children without AS, and significantly more days with OCS use. Rates of asthma-related hospitalizations, emergency department visits, and health care costs were significantly higher among children with AS than among children without AS. CONCLUSIONS: Children with SPC asthma and AS have relatively greater asthma-related health care use and costs compared with children with SPC asthma without AS. (C) 2020 The Authors. Published by Elsevier Inc. on behalf of the American Academy of Allergy, Asthma & Immunology.