James T Li

Mayo Foundation for Medical Education and Research, Scottsdale, AZ, United States

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Publications (27)222.12 Total impact

  • 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. · 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. · 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. · 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: 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. · 3.35 Impact Factor
  • Kaiser Lim, James T Li
    The Journal of allergy and clinical immunology 11/2011; 128(5):1135-6.e1-10. · 12.05 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. · 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. · 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. · 2.25 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. · 3.35 Impact Factor
  • Source
    The Journal of allergy and clinical immunology 06/2010; 125(6):1412-3; author reply 1413-4. · 12.05 Impact Factor
  • Article: Reply.
    Matthew A Rank, James T Li
    The Journal of allergy and clinical immunology 03/2010; · 12.05 Impact Factor
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    ABSTRACT: Mutations in the TNFRSF13B (TACI) gene have been reported to be associated with Common Variable ImmunoDeficiency (CVID). Of 48 patients evaluated within the immunodeficiency clinic, 39 had CVID, 6 had symptomatic IgA deficiency (IgAD) with or without IgG2 and IgG4 subclass deficiency, while 3 had unclassified immune dysregulatory disorders. In all 48 patients TACI genetic testing was performed, and monoallelic mutations were observed in 4 of the 39 CVID patients (10.26%), an incidence comparable to other studies. Of the 6 IgAD patients, 1 had a heterozygous TACI mutation (16.67%), while of the 3 unclassified patients, 1 had a monoallelic TACI mutation (33.3%), but his sibling who also had the same mutation had CVID. The A181E mutation is one of the statistically significant, among the known TACI gene mutations. Here, 5 of the 6 patients were found to have the A181E mutation (10.42%), which is higher than previously observed. We also evaluated 114 controls and found the A181E mutation in only 1 individual (0.88%). We report in this study that the A181E mutation is associated with a very heterogeneous clinical presentation along with variability in B-cell numbers and amount of TACI protein on memory B cells.
    Human immunology 02/2010; 71(5):505-11. · 2.55 Impact Factor
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    ABSTRACT: Cephalosporin administration in patients with a history of penicillin allergy is controversial. Studies looking at the safety of cephalosporin in patients with a history of penicillin allergy lacked a control group, had a small number of patients, and/or lacked confirmation of penicillin allergy by penicillin skin testing. The purpose of this study was to determine whether patients with penicillin allergy were at increased risk of adverse drug reactions when administered cephalosporin. A cohort study of patients with a history of penicillin allergy and a positive or negative penicillin skin test when administered cephalosporin was conducted. Charts were reviewed for adverse drug reactions to cephalosporin after penicillin skin testing. Eighty-five patients with a history of penicillin allergy and positive penicillin skin test and 726 patients with a history of penicillin allergy and negative penicillin skin test were administered cephalosporin. Five (6%) of 85 cases had an adverse drug reaction to cephalosporin as compared to 5 (0.7%) of 726 of the referent population (p = 0.0019). The rate of presumed IgE-mediated adverse drug reactions to the cephalosporins amongst the cases was 2 (2%) of 85 compared to 1 (0.1%) of 726 amongst the referent population (p = 0.0304). A greater risk of an adverse drug reaction to cephalosporin exists in patients with penicillin allergy. We recommend penicillin skin testing if cephalosporin, especially a first-generation cephalosporin, is to be administered to patients with a history of penicillin allergy.
    International Archives of Allergy and Immunology 01/2010; 153(3):268-73. · 2.25 Impact Factor
  • Matthew A Rank, James T Li
    The Journal of allergy and clinical immunology 10/2009; 124(5):1123-6. · 12.05 Impact Factor
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    ABSTRACT: Anaphylaxis guidelines recommend that patients with a history of anaphylactic reaction should carry self-injectable epinephrine and should be referred to an allergist. To evaluate how frequently patients dismissed from the emergency department after treatment for anaphylaxis received a prescription for self-injectable epinephrine or allergist referral. A retrospective medical record review identified patients with anaphylaxis in a community-based study from 1990 through 2000. Records of patients with Hospital Adaptation of the International Classification of Diseases, Second Edition or International Classification of Diseases, Ninth Revision codes representing anaphylaxis were reviewed, and a random sample of patients with associated diagnoses was also reviewed. Patients who met the criteria for diagnosis of anaphylaxis were included in the study. Among 208 patients identified with anaphylaxis, 134 (64.4%) were seen in the emergency department and discharged home. On dismissal, 49 patients (36.6%; 95% confidence interval [CI], 28.4%-44.7%) were prescribed self-injectable epinephrine, and 42 patients (31.3%; 95% CI, 23.5%-39.2%) were referred to an allergist. Treatment with epinephrine in the emergency department (odds ratio, 3.6; 95% CI, 1.6-7.9; P = .001) and insect sting as the inciting allergen (odds ratio, 4.0; 95% CI, 1.6-10.5; P = .004) were significantly associated with receiving a prescription for self-injectable epinephrine. Patient age younger than 18 years was the only factor associated with referral to an allergist (P = .007). Most patients dismissed after treatment for anaphylaxis did not receive a self-injectable epinephrine prescription or allergist referral. Emergency physicians may be missing an important opportunity to ensure prompt treatment of future anaphylactic reactions and specialized follow-up care.
    Annals of allergy, asthma & immunology: official publication of the American College of Allergy, Asthma, & Immunology 01/2009; 101(6):631-6. · 2.75 Impact Factor
  • The Lancet 12/2008; 372(9653):1878. · 39.21 Impact Factor
  • Article: The Reply.
    W Brett Cherry, James T Li
    The American journal of medicine 11/2008; 121(10):e15. · 5.30 Impact Factor
  • Source
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    ABSTRACT: To test several patient-oriented asthma outcome measures and the Healthcare Effectiveness Data and Information Set (HEDIS) measure of appropriate medication for persistent asthma to determine the most useful quality indicator of asthma care. Prospective mail survey of adult employees and dependents with asthma. The medical and pharmacy claims of all subjects from 12 months before and after the survey were abstracted. Outcomes measures included the Asthma Control Test (ACT), workday loss, unscheduled healthcare utilization (emergency department and inpatient care), and satisfaction with care. Although 81% of all responders had wellcontrolled asthma, persistent asthma was uncontrolled in 28%. Only 64.5% received appropriate controller medication. Well-controlled asthma is associated with a high degree of satisfaction, less workday loss, fewer prednisone bursts, and minimal unscheduled healthcare utilization. Except for a reduced incidence of more than 2 oral corticosteroid dispensings (6.4% vs 13.6%, P = .012), compliance with the HEDIS appropriate medication for asthma was not positively associated with any of the patient-centered outcomes studied. Asthma control was the most useful patient outcome quality indicator in this study. Compliance with the HEDIS asthma measure in this population was not associated with a better patient-oriented outcome. This finding may be different with different levels of asthma control. The positive association between well-controlled asthma and patient satisfaction, minimal unscheduled healthcare utilization, and low workday loss suggests that asthma control as measured by ACT may be a better performance measure in asthma.
    The American journal of managed care 09/2008; 14(8):487-94. · 2.17 Impact Factor
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    ABSTRACT: Primary immunodeficiencies comprise many diseases caused by genetic defects primarily affecting the immune system. About 150 such diseases have been identified with more than 120 associated genetic defects. Although primary immunodeficiencies are quite rare in incidence, the prevalence can range from one in 500 to one in 500 000 in the general population, depending on the diagnostic skills and medical resources available in different countries. Common variable immunodeficiency (CVID) is the primary immunodeficiency most commonly encountered in clinical practice, and appropriate diagnosis and management of patients will have a significant effect on morbidity and mortality as well as financial aspects of health care. Advances in diagnostic laboratory methods, including B-cell subset analysis and genetic testing, coupled with new insights into the molecular basis of immune dysfunction in some patients with CVID, have enabled advances in the clinical classification of this heterogeneous disease.
    The Lancet 09/2008; 372(9637):489-502. · 39.21 Impact Factor

Publication Stats

269 Citations
222.12 Total Impact Points


  • 2002–2012
    • Mayo Foundation for Medical Education and Research
      • • Department of Pediatric and Adolescent Medicine
      • • Department of Allergic Diseases
      Scottsdale, AZ, United States
  • 2007–2010
    • Mayo Clinic - Rochester
      • • Department of Laboratory Medicine & Pathology
      • • Department of Allergic Diseases
      Rochester, MN, United States