Predictors of frequent exacerbations in childhood asthma: Associations with allergic comorbidities and type 2 biomarkers

Purpose: Frequent exacerbations (FEs) of asthma often present with poor response to standardized treatment and are associated with an unfavorable prognosis.However, the risk factors for FEs in children remain unclear.Methods: This retrospective study reviewed pediatric patients with asthma between January 2016 and August 2022 at a tertiary center in South Korea.Over 2 years, we followed up patients with FEs defined as 2 or more emergency department visits or hospitalizations for asthma exacerbations per year.Results: Of 558 patients, 56 were classified as FEs.Multivariate regression analysis identified younger age (odds ratio [OR], 2.75; P= 0.002), higher steps of asthma management (OR, 10.88; P< 0.001), comorbid allergic rhinitis (OR, 0.38; P= 0.003), comorbid food allergies (OR, 2.60; P= 0.003), and sensitization to class 1 food allergens (OR, 3.08; P= 0.001) as significant risk factors for FEs.Additionally, eosinophil cationic protein levels (OR, 0.99; P= 0.001) and white blood cell counts (OR, 1.60; P= 0.001) were identified as laboratory predictors.In subgroup analysis by age 6, higher asthma management steps (P= 0.005 and P= 0.046) and class 1 food allergen sensitization (P= 0.037 and P= 0.026) were consistently identified as significant risk factors for FEs in both age subgroups.Conclusion: It is suggested that younger age, absence of comorbid allergic rhinitis, presence of comorbid food allergy, and class 1 food allergen sensitization may be the potential predictors of FEs in pediatric asthma patients.