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Non-invasive methods used to assess asthma include the measurement of fractional exhaled nitric oxide (FeNO), serum periostin levels, and the mannitol provocation test. Exercise-induced bronchoconstriction (EIB) is a distinct form of bronchial hyperresponsiveness (BHR), and is a cardinal feature of asthma. This study examined the utility of non-invasive methods in detecting EIB in asthmatic children. METHODS: The study enrolled 41 asthmatic children between 6 and 15 years old. We measured FeNO and serum periostin levels and performed pulmonary function tests at baseline and mannitol inhalation. An exercise bronchoprovocation test was used for EIB diagnosis, the results of which were considered positive with a 15% or greater decrease in forced expiratory volume in 1 second (FEV 1) after exercise. RESULTS: Twenty six (63.4%) subjects with asthma showed positive exercise challenge tests. The maximum decrease in %FEV 1 after exercise was positively correlated with FeNO (r 5 0.468, p 5 0.008), the response-dose ratio (RDR) to mannitol (r 5 361, p 5 0.046), and serum periostin level (r 5 0.373, p 5 0.039) in asthmatics with EIB. To discriminate between asthmatics with and without EIB based on non-invasive methods, receiver operating characteristic curve analyses were performed. No significant difference was observed among the area under the curve values for FeNO, RDR to mannitol, or serum periostin levels. CONCLUSIONS: FeNO levels, BHR to mannitol, and serum periostin levels were significantly correlated with maximum decreases in %FEV 1 after exercise. No significant difference was observed regarding the diagnostic properties of these methods for detecting EIB in asthmatic children.

RATIONALE: The effect outpatient penicillin allergy testing has on future healthcare utilization (HU) and morbidity is unknown. METHODS: HU and morbidity in 500 penicillin allergic cases, only 8 penicillin allergy test-positive, seen from 6-8-2010 to 3-29-2012, were compared to non-tested controls. Five penicillin allergic controls were matched to each case by gender, age, weighted Charlson comorbidity index (CCI), and outpatient office visits during a 2-year lead-in period. Hospital days, new drug allergies, and antibiotic exposures were determined over a 36 to 62 month follow-up period. RESULTS: Cases had a mean (95% CI) lead-in CCI of 1.65 (1.44-1.87) and 13.73 (12.76-14.7) outpatient visits per year of healthplan coverage (YHC). Controls had a mean lead-in CCI of 1.7 (1.6-1.8) and 12.08 (11.69-12.47) outpatient visits per YHC. For cases, hospital days per YHC increased significantly less than for control subjects, 1.62 (1.13-2.11) to 2.16 (1.00-3.31) [133%] versus 0.73 (0.59-0.87) to 2.02 (1.43-2.61) [277%], (p < 0.0001). Antibiotic courses per year fell significantly more in cases, -0.85 versus -0.62, (p 5 0.0212). Cases had significantly fewer new drug allergies at the end of the follow-up period, +0.044 versus +0.18, (p < 0.0001). The top 5 antibiotics cases were exposed to were penicillins, 1 st generation cephalosporins, quinolones, tetracyclines, and macrolides versus macrolides, quinolones, clindamycin, 1 st generation cephalosporins, and tetracyclines for controls. CONCLUSIONS: Penicillin allergy testing was associated with a smaller increase in hospital days, a greater fall in antibiotic usage, fewer new drug allergies, and significantly less macrolide, quinolone, and clindamycin exposure over the next 3 to 5 years.