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Updated: Aug 9, 2026

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Published on: August 7, 2017

Race Adjusted for Social and Environmental Disparities Is the Principal Determinant of T2HIGH Inflammation in

W Gerald Teague1, Ava Noth2, Marina Lynch3

  • 1Child Health Research Center, Department of Pediatrics, University of Virginia School of Medicine (SOM), Charlottesville, Va; Division of Respiratory Medicine and Sleep, Department of Pediatrics, University of Virginia SOM, Charlottesville, Va; Beirne Carter Center for Immunology Research, University of Virginia SOM, Charlottesville, Va; Pediatric Aerodigestive Service, University of Virginia Heath Children's, Charlottesville, Va.

The Journal of Allergy and Clinical Immunology. in Practice
|August 7, 2026
PubMed

Insights

Black children with severe asthma have higher T2-high inflammation, a marker of difficult symptoms. This finding, adjusted for various factors, suggests race and inflammation levels should guide treatment for pediatric severe asthma.

Area of Science:

  • Pediatric Allergy and Immunology
  • Respiratory Medicine
  • Genetics and Genomics

Background:

  • Severe asthma in children is often driven by T-helper two (T2) inflammation, leading to challenging symptoms.
  • Studies indicate Black children exhibit greater T2 inflammation than White children, but underlying factors remain unclear.

Purpose of the Study:

  • To identify key factors distinguishing T2-high from T2-low inflammation phenotypes in children with severe, treatment-refractory asthma.
  • To investigate the influence of demographic, social, environmental, and clinical factors on T2 inflammation in pediatric severe asthma.

Main Methods:

  • Children with severe asthma underwent bronchoscopy and blood T2 marker analysis.
  • Phenotypes were classified as T2-high (eosinophilia, specific IgE) or T2-low.
  • Multivariable logistic regression and neural network models analyzed factors associated with T2-high inflammation.

Main Results:

  • The T2-high phenotype was prevalent by age five.
  • Compared to T2-low, T2-high children were older, more likely to be Black, had lower income, more hospitalizations, reduced FEV1, and higher BAL granulocytes.
  • Black race/ethnicity showed the highest odds ratio for T2-high inflammation, even after adjusting for social, environmental, and clinical factors.

Conclusions:

  • In pediatric severe asthma, Black race is the strongest predictor of T2-high inflammation, independent of other factors.
  • Treatment strategies for severe asthma in children should consider both race/ethnicity and the degree of T2 inflammation.
Abstract

Keywords:
Black race and ethnicityProblematic wheezeSevere asthmaSocial disparitiesT-helper 2 inflammation

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