RESUMO
Background: Individuals with severe asthma represent 5%-10% of the general asthmatic population. Despite the use of biologic drugs during clinical management, inadequate control of the disease has translated into high economic impact. In Mexico, however, these costs have not yet been assessed. Methods: A retrospective cohort study was carried out in 2018 and 2019 at Regional Hospital Lic. Adolfo López Mateos, ISSSTE. The assessment of direct costs included pharmacological treatment, clinical tests, days of hospitalization, admissions to the emergency room, and scheduled consultations. The evaluation involved 2 groups of patients-with controlled severe asthma (CSA) and uncontrolled severe asthma (UCSA)-according to presence of exacerbations. Results: 60 patients (18-75 years old, 51 women) were included in the study. In 2018, 23 of them (38.3%) were categorized as belonging to the UCSA group; in 2019, 22 patients (36.7%) were in this condition (exacerbations: median = 1.5, maximum = 6). Of the 60 patients, 12 (20%) presented between 2 and 9 exacerbations in the study's two-year period (median = 3) after between 4 and 10 years (median = 7.8) of complementary anti-immunoglobulin E (IgE) therapy with omalizumab. The cost for all patients in the 2018-2019 period was 993,289.60 USD. The mean cost per patient was higher for those with UCSA (16,392 USD) than for those with CSA (16,246 USD, p = 0.02). We found a positive association between cost and exacerbations, with an increase of 350 USD per exacerbation (pË0.0001). Our results indicate that 62% of patients respond to complementary anti-IgE treatment, while 38%-and especially 20%-do not respond optimally to this treatment. Conclusions: Poor asthma control in this latter group of 38% of patients leads to lower quality of life and higher costs associated with pharmacological treatment.
RESUMO
BACKGROUND: The atopic march is characterized by the sequential presence of food allergy, atopic dermatitis, rhinitis and asthma. Risk factors for the progression of the allergic disease defined as atopic march have not been established. OBJECTIVE: To determine the associated factors with the development of atopic march in children between the ages of 2 and 12 years. METHODS: This case-control study included children between 2 and 12 years of age, 50 in the group of atopic march and 50 controls, characterized by an allergic disease. A questionnaire on atopic antecedents was given, skin tests with allergens were performed to the patients and their parents, and the level of serum IgE was measured. RESULTS: We found as associated risk factors for the development of atopic march, the following: male sex (OR= 3.62), positive skin tests in their parents (OR=2.66) and urinary tract and gynecologic infections during pregnancy (OR = 4.95). CONCLUSIONS: Male sex, sensitization to allergens in their parents and maternal infections during pregnancy are associated risk factors for the development of atopic march in children.
