Allergic Polysensitization Clusters: Newly Recognized Severity Marker in Urban Asthmatic Adults.

INTRODUCTION: While reliable, quantitative in vitro testing for sensitivity to aeroallergens has been available for decades, such information has largely been ignored in clustering analyses of asthma. Our aim is to explore allergic polysensitization as a possible marker of asthma severity and, as such, to be considered as an integral marker in future asthma clustering analyses. METHODS: We constructed a database of sensitizations to the 25 aeroallergens in our geographic area (zone 1, Northeastern US) using the ImmunoCAP® in vitro assay. We used the Scikit-Learn® machine learning library for model-based clustering to identify allergic polysensitization clusters. Clusters were compared for differences in common office-based clinical markers of asthma. RESULTS: The database consisted of 509 patients. Unbiased machine learning identified ten clusters of increasing allergic polysensitization of varying sizes (n = 1-339) characterized by significant increases in mean serum immunoglobulin E (p < 0.001), peripheral blood eosinophil count (p < 0.001), and DLCO (p = 0.02). There was a significant decline in mean age at presentation (p < 0.001), FEV1/FVC (p = 0.01), and FEF25-75 (p = 0.002) with increasing allergic polysensitization. Finally, we identified two divergent paths for the poly-atopic march, one driven by perennial and the other by seasonal allergens. CONCLUSION: This pilot study showed that allergic polysensitization, using readily available qualitative and quantitative in vitro sensitization data, largely ignored in cluster analyses to date, may add further clinical precision in cluster analyses of asthma. We suggest the methods used here can be applied and tested using larger databases and aeroallergens present in diverse geographic regions.

Alternative and Complimentary Medication Use in Singers: A Pilot Survey.

OBJECTIVE: Cannabidiol (CBD) is an active ingredient in marijuana that has demonstrated anti-inflammatory properties. It's therapeutic potential and accessibility has made the product popular. Over the counter products (OTC) products have also demonstrated therapeutic potential and have been accessible in public markets for a long time. The objective was to better understand the use of CBD and OTC products amongst singers with varying singing styles. METHODS: An anonymous online survey was distributed to 1053 singers via The Research Electronic Data Capture (RED-Cap) program in association with Drexel University. The survey aimed to obtain information regarding singing proficiency, styles, if respondents used CBD/OTC products, reasons for use, perceived effects on the voice due to use of these products, and how informed were they in regards to use of these products. RESULTS: From 1053 singers, we obtained 144 respondents (response rate of 13.7%). The average age of respondents was 51.8 years; There were 47 males, 93 females, and four who were nonbinary or preferred not to provide their gender. The majority of respondents (63.2%) were professional singers. Primary singing styles included operatic (18.1%), sacred (20.8%), and musical theater (20.1%). Eighty-seven point five percent of respondents reported warming up before singing and 22.9% reported cooling down after singing. Thirteen respondents reported use of a cannabidiol (CBD) product. Information resources for CBD used primarily came from an online website (38.5%). Among the 13 respondents who reported use of CBD products, 46.2% of these respondents did not notice any positive effects and 46.2% reported no negative effects on the voice when using CBD products. Eighty-two respondents (56.9%) reported use of an OTC, supplement, or alternative medicine product. Majority received Information resources from a physician or other healthcare provider (81.7%). The most frequently reported OTC or complimentary medications used were reflux medications, antihistamines, acetaminophen, and NSAIDs. Reduced inflammation, improved voice recovery, improved voice quality, and improved voice endurance were commonly reported positive effects on the voice with OTC/AM use. Vocal strain, hoarseness, and dryness were the most commonly reported negative effects on the voice with OTC/AM use. CONCLUSIONS: Stress, anxiety, or chronic pain was often the primary reason for CBD use amongst singers. The most common OTC medications were used reflux medications, antihistamines, acetaminophen, and NSAIDs.