James T Li

Mayo Clinic - Rochester, Рочестер, Minnesota, United States

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Publications (60)448.47 Total impact

  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2015; DOI:10.1016/j.anai.2014.11.016 · 2.75 Impact Factor
  • 08/2014; DOI:10.1016/j.jaip.2014.07.010
  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 10/2013; 111(4):301-2. DOI:10.1016/j.anai.2013.07.030 · 2.75 Impact Factor
  • Thanai Pongdee, James T Li
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    ABSTRACT: To review the literature regarding the pathophysiology of exercise-induced bronchoconstriction (EIB). The databases of PubMed, Ovid MEDLINE, and Scopus were searched for articles using the subject headings and/or keywords asthma, exercise-induced/etiology, exercise, mechanism, pathogenesis, and bronchoconstriction. Articles were selected based on their relevance to the focus of this review, with emphasis on the specific pathophysiologic mechanisms of EIB. EIB occurs in response to the loss of water from the lower airways that results from heating and humidifying large volumes of air in a short period. The resulting hyperosmolar environment activates various cellular mechanisms to release mediators from mast cells, eosinophils, epithelial cells, and sensory nerves. These mediators, in turn, lead to airway smooth muscle contraction and bronchoconstriction. Airway hyperresponsiveness in elite athletes may develop from a process of airway injury and changes in the contractile properties of airway smooth muscle. EIB commonly affects individuals with and without clinically recognized asthma, especially those who participate in competitive athletics. Through years of research, the pathophysiology of EIB is now better understood and involves a complex interaction between several different cell types and mediators. Continued research to improve the knowledge regarding the mechanisms of EIB should aid the identification, diagnosis, and treatment of this common condition.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 05/2013; 110(5):311-5. DOI:10.1016/j.anai.2013.02.002 · 2.75 Impact Factor
  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 03/2013; 110(3):205-6. DOI:10.1016/j.anai.2012.12.005 · 2.75 Impact Factor
  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2013; 110(1):57-8. DOI:10.1016/j.anai.2012.10.009 · 2.75 Impact Factor
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    ABSTRACT: Objectives: To describe how the types of healthcare expenditures for patients with asthma have changed over the past decade. Study Design: Cross-sectional comparison between individuals from 1996 to 1998 and 2004 to 2006. Methods: Expenditures among US individuals (aged 5 to 56 years) with asthma were compared using the 1996 to 1998 and the 2004 to 2006 Medical Expenditure Panel Surveys. Direct expenditures (medications, inpatient, outpatient, and emergency services) and changes in productivity (missed school and work days) were compared over this time frame. The adjusted analyses controlled for age, education level, race/ethnicity, gender, poverty, region, metropolitan statistical area, self-reported health, and Charlson Comorbidity Index. Results: Mean annual per capita healthcare expenditures increased between 1996 to 1998 and 2004 to 2006 ($3802 vs $5322 inflated to 2010 US dollars, P <.0001). Annual medication expenditures doubled from $974 to $2010 per person (P <.0001) and outpatient visit expenditures increased from $861 to $1174 (P <.0001) while hospitalization and emergency department (ED) visit expenditures were similar over the same time period. Missed school and work days decreased between the 2 periods (9.23 days in 1996-1998 vs 6.39 days in 2004-2006, P = .001). Conclusions: An increase in total direct expenditures in individuals with asthma was largely driven by an increase in spending on medications comparing 2004 to 2006 and 1996 to 1998 data. However, this increase was not offset by lower spending on hospitalization and ED visits.
    The American journal of managed care 09/2012; 18(9):499-504. · 2.17 Impact Factor
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    ABSTRACT: BACKGROUND Because of concerns about the safety of long-acting β2-agonist (LABA) use in patients with asthma, withdrawal of the LABA is recommended by the US Food and Drug Administration once asthma is controlled by combination therapy with a LABA and inhaled corticosteroid (ICS). OBJECTIVE To perform a systematic review and meta-analysis assessing evidence supporting the discontinuation of LABA therapy once asthma control has been achieved with a combination of ICS and LABA. DATA SOURCES MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases were searched (through August 2010), references of identified studies and selected narrative review articles were evaluated, registries of clinical trials were reviewed, and manufacturers of LABAs were contacted. STUDY SELECTION Randomized controlled trials of discontinuation of LABA therapy in patients with asthma controlled with a combination of ICS and LABA. DATA EXTRACTION Two reviewers independently screened each title and abstract in the initial searches and then the full text of each nominated article to extract data for analyses. RESULTS Of 1492 screened articles, only 5 trials involving patients aged 15 years or older fulfilled a priori-specified inclusion criteria. Results did not favor the LABA step-off approach compared with no change in treatment. The LABA step-off regimen increased asthma impairment, with worse Asthma Quality of Life Questionnaire score (mean difference [95% CI], 0.32 [0.14-0.51] points lower); worse Asthma Control Questionnaire score (0.24 [0.13-0.35] points higher); fewer symptom-free days (9.15% [1.62%-16.69%] less); and greater risk of withdrawal from study resulting from lack of efficacy or loss of asthma control (risk ratio, 3.27 [2.16-4.96]). Risk of exacerbations and deaths after LABA step-off were not evaluable because of the small number of events and short duration of follow-up. CONCLUSIONS Evidence suggests that discontinuing LABA therapy in adults and older children with asthma controlled with a combination of ICSs and LABAs results in increased asthma-associated impairment. Additional trials measuring all long-term patient-important outcomes are needed.
    Archives of internal medicine 08/2012; 172(18):1-11. DOI:10.1001/archinternmed.2012.3250 · 13.25 Impact Factor
  • The Journal of allergy and clinical immunology 05/2012; 130(1):25-43. DOI:10.1016/j.jaci.2012.04.003 · 11.25 Impact Factor
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    ABSTRACT: Allergist/clinical immunologist maintenance of certification and training program reaccreditation are mandatory in some countries. The World Allergy Organization conducted surveys in 2009 and 2011 to assess where such programs were available and to promote the establishment of such programs on a global level. This was done with the presumption that after such an "inventory," World Allergy Organization could offer guidance to its Member Societies on the promotion of such programs to assure the highest standards of practice in the field of allergy and clinical immunology. This review draws on the experience of countries where successful programs are in place and makes recommendations for those wishing to implement such programs for the specialty.
    World Allergy Organization Journal 04/2012; 5(4):45-51. DOI:10.1097/WOX.0b013e31825546b4
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    ABSTRACT: Influenza is known to be associated with asthma exacerbation but the effectiveness of the trivalent inactivated flu vaccine (TIV) in children, especially children with asthma, in preventing hospitalization is unknown. We assessed the effectiveness of the TIV in all children and especially children with asthma to prevent hospitalization with influenza. We conducted a nested case control study of all pediatric subjects (6 months to 18 years old) who were evaluated at the Mayo Clinic, Rochester, MN, who had laboratory-confirmed influenza during each flu season from 1999 to 2006 to evaluate the efficacy of TIV in preventing hospitalization. A case-control analysis was performed with the cases and the controls being the subjects who did and did not required hospitalization with the influenza illness, respectively. There were 261 subjects with laboratory-confirmed influenza from 1996 to 2006. There was an overall trend toward higher rates of hospitalization in subjects who got the TIV when compared with the ones who did not get the TIV (odds ratio [OR], 3.67; CI, 1.6, 8.4). Using the Cochran-Mantel-Haenszel test for asthma status stratification, there was a significant association between hospitalization in asthmatic subjects and TIV (p = 0.001). TIV did not provide any protection against hospitalization in pediatric subjects, especially children with asthma. On the contrary, we found a threefold increased risk of hospitalization in subjects who did get the TIV vaccine. This may be a reflection not only of vaccine effectiveness but also the population of children who are more likely to get the vaccine.
    Allergy and Asthma Proceedings 03/2012; 33(2):e23-7. DOI:10.2500/aap.2012.33.3513 · 3.35 Impact Factor
  • Kaiser Lim, James T Li
    The Journal of allergy and clinical immunology 11/2011; 128(5):1135-6.e1-10. DOI:10.1016/j.jaci.2011.09.021 · 11.25 Impact Factor
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    ABSTRACT: Angioedema is often treated in the emergency department (ED). Few studies have evaluated self-injectable epinephrine (SIE) prescribing patterns for angioedema. To describe presentation and management of ED patients with angioedema and determine factors associated with epinephrine administration, hospital admission and SIE prescription. We conducted a retrospective cohort study of all ED patients with angioedema between January 2005 and December 2006. Of 63 patients, 39 (61.9%) were female. Median age was 49 years. Precipitating factors were identified in 36 (57.1%) patients. History of other allergic conditions was seen in 37 (58.7%) patients. Seventeen (27.0%) patients received epinephrine, 55 (87.3%) received antihistamines, and 51 (81.0%) received steroids. Epinephrine was administered more commonly in patients with edema of the tongue (risk ratio [RR], 5.28, 95% confidence interval [CI] 1.95-14.33, P = .0003), tightness/fullness of throat (RR, 3.31, 95% CI 1.62-6.76, P = .006), and dyspnea/wheeze (RR, 3.04, 95% CI 1.41-6.59, P = .005). Hospitalization was more common in patients with dyspnea/wheeze (P = .028) and allergic history (P = .006). Thirteen patients (22.0%) were discharged with SIE. An SIE prescription was associated with younger patients (median age, 26 years [interquartile range (IQR) 15-50] vs a median age 57.5 years [IQR 43-68], P = .004) and patients with throat tightness/fullness (RR, 4.2, 95% CI 1.8-9.8, P = .005). Patients with respiratory symptoms and allergic history were likely to be admitted. Epinephrine use was more frequent in patients with signs and symptoms of oropharyngeal edema. Younger patients and those with tightness/fullness of throat were likely to be prescribed SIE. Further studies are needed to determine who would benefit from epinephrine use and SIE prescription.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 06/2011; 106(6):489-93. DOI:10.1016/j.anai.2011.01.028 · 2.75 Impact Factor
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    ABSTRACT: Over 90% of patients with a history of penicillin allergy have negative penicillin skin tests. Pharmacists are trained to identify and resolve medication-related problems. We hypothesized that collaboration between allergists and pharmacists to identify and evaluate patients with a history of penicillin allergy would increase β-lactam antibiotic prescription. We conducted a prospective observational study in which patients with a history of penicillin allergy were identified and educated at the pharmacy about penicillin allergy and offered an allergist consultation with a penicillin skin test. All patients were followed up to determine which antibiotics were subsequently prescribed. A total of 503 patients were enrolled, and 71 (14%) were evaluated by an allergist. Sixty-seven of these 71 patients (94%) had a negative penicillin skin test. Twenty-nine patients evaluated by an allergist and 205 patients not evaluated were prescribed antibiotics. Patients prescribed antibiotics and evaluated by an allergist were compared to those not evaluated by an allergist, with the following results: 19 of 29 patients (66%) were prescribed a β-lactam antibiotic compared to 54 of 205 (26%; p < 0.0001); 8 of 29 patients (28%) were prescribed penicillin compared to 7 of 205 (3%; p < 0.0001); 15 of 29 patients (52%) were prescribed a cephalosporin compared to 48 of 205 (23%; p < 0.01), and 10 of 29 patients (34%) were prescribed a non-β-lactam antibiotic compared with 177 of 205 (86%; p < 0.0001). A collaborative effort between allergists and pharmacists can increase β-lactam antibiotic prescriptions and decrease non-β-lactam prescriptions in patients with a history of penicillin allergy.
    International Archives of Allergy and Immunology 01/2011; 154(1):57-62. DOI:10.1159/000319209 · 2.43 Impact Factor
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    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2011; 106(1):11-6. DOI:10.1016/j.anai.2010.11.015 · 2.75 Impact Factor
  • Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2011; 106(1):76-7. DOI:10.1016/j.anai.2010.10.024 · 2.75 Impact Factor
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    ABSTRACT: The safety of H1N1 vaccine is unknown in egg allergic (EA) recipients. To establish the safety of administering H1N1 vaccine and to evaluate the predictability of H1N1 skin testing in EA patients. In a controlled, prospective trial, H1N1 skin testing and vaccination was compared between EA patients (n = 105) and non-EA controls (n = 19). Those with negative H1N1 skin test results received a full H1N1 dose; those with a positive skin test result received a graded challenge (10%, 90%). Booster vaccine, if required, was given as a single dose from a different lot without prior testing. Prick and intradermal test results were positive in 3 (2.4%) of 124 and 41 (33.1%) of 124 study participants, respectively. Forty-one individuals received a 2-step graded vaccine challenge, including 13 of 25 with a history of egg anaphylaxis. No significant allergic reactions resulted from either method of vaccination or from subsequent booster doses. All study participants received the H1N1 vaccine without significant allergic reactions. Skin testing is unnecessary and does not predict vaccine tolerance. All study participants who received a graded challenge tolerated a single dose booster from a different, untested lot, including 7 individuals with a history of egg-induced anaphylaxis. We recommend administration of H1N1 vaccine to EA children without prior skin testing or graded challenge dosing.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 11/2010; 105(5):387-93. DOI:10.1016/j.anai.2010.08.015 · 2.75 Impact Factor
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    ABSTRACT: Previous studies using cross-sectional designs suggest that asthma trigger recognition and management are suboptimal in clinical practice. The objective of this study was to assess gaps between asthma guideline recommendations and clinical practice regarding asthma trigger recognition and management by tracking poorly controlled asthma patients over a 2-year period. A retrospective cohort study of a representative sample of 102 children and adult residents of Olmsted County, MN, with poor asthma control in 2003-2004 was performed. All medical records from each asthma-related visit were examined for documented asthma trigger inquiries, specific trigger avoidance advice, and for adherence to the trigger avoidance advice. One hundred two subjects made 686 asthma-related visits that were included for analysis. At least 1 trigger inquiry occurred in 83% of visits, with an average of 2.0 triggers queried per visit. The most common trigger inquiries were for infection (47%), environmental tobacco smoke (41%), and allergens (29%). The mean number of triggers queried was higher during exacerbation visits versus nonexacerbation visits (2.1 versus 1.8; p < 0.001) and in the emergency care settings compared with outpatient settings (2.4 versus 1.7; p < 0.001). Advice for managing asthma triggers was given in 30% of visits and adherence to trigger advice was evaluated at 6% of visits. Future interventions for improving asthma trigger management should be targeted to routine asthma outpatient visits, where trigger avoidance advice is infrequent and rarely addressed in follow-up visits.
    Allergy and Asthma Proceedings 10/2010; 31(6):99-105. DOI:10.2500/aap.2010.31.3405 · 3.35 Impact Factor
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    The Journal of allergy and clinical immunology 06/2010; 125(6):1412-3; author reply 1413-4. DOI:10.1016/j.jaci.2010.03.009 · 11.25 Impact Factor
  • Article: Reply.
    Matthew A Rank, James T Li
    The Journal of allergy and clinical immunology 03/2010; DOI:10.1016/j.jaci.2010.01.027 · 11.25 Impact Factor

Publication Stats

2k Citations
448.47 Total Impact Points


  • 1998–2015
    • Mayo Clinic - Rochester
      • • Department of Allergic Diseases
      • • Department of Emergency Medicine
      Рочестер, Minnesota, United States
    • American Academy of Allergy Asthma & Immunology
      Rochester, New York, United States
    • Pennsylvania State University
      • Department of Pediatrics
      University Park, Maryland, United States
  • 2010–2012
    • Mayo Foundation for Medical Education and Research
      • • Department of Pediatric and Adolescent Medicine
      • • Department of Allergic Diseases
      Scottsdale, AZ, United States
  • 2007
    • University of Minnesota Rochester
      Рочестер, Minnesota, United States
  • 2003
    • Asthma Allergy & Immunology Institute
      Southfield, Michigan, United States
  • 1996
    • Johns Hopkins University
      • Department of Medicine
      Baltimore, MD, United States