By Marie Rosenthal, MS

The presence of allergic immune diseases, such as atopic dermatitis, in adults is an advantage among patients with sepsis, but that same effect is not seen in children, at least according to a small study presented at the 2025 Critical Care Congress.

About 20% of the U.S. population has an atopic disease, which appears to improve the prognosis for adults with sepsis (Crit Care Med 2019;47[12]:1735-1742). 

“Type 2 immune response in atopic diseases can mediate beneficial tissue repair functions through greater mast cell degranulation and release of mediators needing to enhance neutrophil influx and killing of bacteria. In adults, atopic disease shows better prognosis in critically ill patients with sepsis in that there was lower risk of ICU admission and shorter hospital length of stay [LOS],” explained Leona R. Montero, MD, the pediatric chief resident at Northwell Health, Cohen Children’s Medical Center, in New Hyde Park, N.Y. 

Dr. Montero and her colleagues wanted to know whether children with T2 atopic disease would also see a benefit if they developed sepsis. They performed a retrospective chart review among patients between 24 months and 17 years of age who were admitted to the pediatric ICU between 2021 and 2023. They included children whose charts showed a clinical concern for sepsis, including those with a positive screen who triggered a sepsis alert with two or more systemic inflammatory response syndrome (SIRS) criteria, who were treated with the use of an order set, including those who received fluid resuscitation and those who had a diagnostic code of sepsis associated with their hospital visit. (SIRS criteria include fever, tachycardia or bradycardia; tachypnea or the need for mechanical ventilation; abnormal leukocyte count; and infection.) 

“We performed a chart review with documented history of asthma, eczema, and food or seasonal allergies, and we looked specifically at demographics, patient outcomes and lab values for our patients,” Dr. Montero said.

They found 1,150 visits, but narrowed it down to 660 visits among patients who received antibiotics because of a high concern for sepsis. Of those 660 patients, they found 85 patients or 13% who had T2 disease or asthma; 575 children who did not fit the inclusion criteria were used as controls. 

“Our primary outcomes were hospital length of stay and duration of antibiotic treatment, and our secondary outcomes were days on a ventilator, days on vasoactive medication and ICU days,” she explained.

After a statistical analysis, they found the parameters were the same or close: The median hospital LOS was 5.00 in both groups (P=0.16), and the antibiotic duration was 2.00 in both groups (P=0.17); the ventilator days was 7.00 in the T2 group and 8.00 in the control group, while the median vasoactive days was 2.00 in the T2 group and 3.00 in the control group. The P value for the final two parameters was P=0.17. “You can see that there was no significant difference between our two groups here. All of our P values were over 0.05,” Dr. Montero said.

“To draw some conclusions from our study, it looks like patients with atopic disease did not show a difference in clinically relevant outcomes compared with their peers without those comorbidities,” Dr. Montero explained. “This might show a difference between adults and pediatric patients with disease, meaning that maybe the type 2 immune response that provided protection in adults is not as robust or developed in our pediatric patients.”

There were several limitations to her study. It was small, so a larger number of patients might be needed to see a difference; the highly sensitive sepsis screening might mean the overtreatment of some patients; it was difficult to eliminate people with asthma and pneumonia from the groups; and the presentation of severe asthma might mimic sepsis signs, making the “recovery” of sepsis more likely related to the elimination of an asthma exacerbation, she said. 

“In the future, we hope to better define our admission criteria for sepsis to better differentiate patients with a higher likelihood of serious bacterial infection to help us better focus in on our research question.” 

Although children with a chronic inflammatory disease did not see the advantage that adults had, they were not at risk for worse outcomes if they develop sepsis than those without the disease, Dr. Montero said.

Dr. Montero reported no relevant financial disclosures.