1. bookVolume 70 (2021): Issue 1 (June 2021)
Journal Details
License
Format
Journal
eISSN
2247-059X
First Published
31 Jan 1951
Publication timeframe
1 time per year
Languages
English
access type Open Access

Is the allergic reaction to Aspergillus a contraindication for biological therapy in severe asthma?

Published Online: 28 May 2022
Volume & Issue: Volume 70 (2021) - Issue 1 (June 2021)
Page range: 55 - 58
Journal Details
License
Format
Journal
eISSN
2247-059X
First Published
31 Jan 1951
Publication timeframe
1 time per year
Languages
English
Abstract

Introduction: According to the available speciality data, a study from the Netherlands has proven that 24% of patients are in Stage 4–5 of the Global Initiative for Asthma guide (GINA) treatment. Among them, 17% have difficult-to-treat asthma and only 3.7% have severe asthma. Patients with severe asthma have a poor prognosis, with numerous exacerbations that are usually severe. Therefore, add-on biological treatments used for eligible patients may change the outcome.

Case report: A 56-year-old female patient, diagnosed 10 years ago with asthma, without professional exposure, treated at home with maximal inhalation treatment, with multiple exacerbations and therefore multiple admissions to the hospital, one of which in the intensive care unit where she received endotracheal intubation and mechanical ventilation, is admitted to the hospital for persistent dyspnoea at rest, wheezing and chest tightness. Investigations revealed obstructive ventilatory dysfunction with a decreased value of forced expiratory volume (FEV1) by 37.57% and a reversibility ratio of 156%. Radiography results indicated absence of acute pleuropulmonary lesions; white blood cells (WBC) at 13,550 and eosinophils at 5566/µL; and 4.107% confirmed immunoglobulin E (IgE)-mediated allergy. The score for asthma control test (ACT) taken on 26 April 2018 was −8 and total IgE was 513 UI/L. Allergology evaluation results did not indicate allergies at prick test. Specific IgE was done for allergy for cat epithelium, guinea pig, rabbit, Penicillium notatum, Cladosporium herbarum and Aspergillus fumigates. Negative fungal test after bronchoscopy was performed to exclude pulmonary Aspergillosis. Omalizumab at 900 mg/month treatment was started. The outcome after 1 year showed no exacerbations, no admissions and no systemic corticotherapy usage.

Discussion: Allergic reaction to Aspergillus does not overlap with the diagnosis of pulmonary Aspergillosis; the condition is rather associated with immunosuppression and with a poor outcome. Severe asthma with prolonged progression and multiple risk factors must be treated with maximal therapy.

Keywords

1. Global Initiative for Asthma - Global Initiative for Asthma - GINA [Internet]. [cited 2020 Dec 14],2020. Available from: https://ginasthma.org/wp-content/uploads/2020/04/GINA-2020-full-report_-final-_wms.pdfSearch in Google Scholar

2. Menzella F, Galeone C, Formisano D, Castagnetti C, Ruggiero P, Simonazzi A, et al. Real-life efficacy of omalizumab after 9 years of follow-up. Allergy, Asthma & Immunology Research. 2017;9(4): 368–372.10.4168/aair.2017.9.4.368544695228497924Search in Google Scholar

3. Loureiro CC, Amaral L, Ferreira JA, Lima R, Pardal C, Fernandes I, et al. Omalizumab for severe asthma beyond allergic asthma. BioMed Research International. 2018. Available from: https://downloads.hindawi.com/journals/bmri/2018/3254094.pdf10.1155/2018/3254094616638330310816Search in Google Scholar

4. Katsaounou P, Buhl R, Brusselle G, Pfister P, Martinez R, Wahn U, et al. Omalizumab as alternative to chronic use of oral corticosteroids in severe asthma. Respiratory Medicine. 2019;150: 51–62. Available from: https://www.resmedjournal.com/article/S0954-6111(19)30039-3/fulltext10.1016/j.rmed.2019.02.00330961951Search in Google Scholar

5. Hogan C, Denning DW. Allergic bronchopulmonary aspergillosis and related allergic syndromes. Seminars in Respiratory and Critical Care Medicine. 2011;32(6): 682–692.10.1055/s-0031-129571622167396Search in Google Scholar

6. Farrant J, Brice H, Fowler S, Niven R. Fungal sensitisation in severe asthma is associated with the identification of Aspergillus fumigatus in sputum. Journal of Asthma. 2016;53(7): 732–735.10.3109/02770903.2016.115407327043956Search in Google Scholar

7. protocoale-2018-MOf-754Bis_18.pdf [Internet]. [cited 2020 Dec 20]. Available from: http://www.inmas.ro/wp-content/uploads/2018/09/protocoale-2018-MOf-754Bis_18.pdfSearch in Google Scholar

8. Lin CH, Cheng SL. A review of omalizumab for the management of severe asthma. Drug Design, Development and Therapy. 2016;10: 2369–2378.10.2147/DDDT.S112208497063827528798Search in Google Scholar

9. Froidure A, Mouthuy J, Durham SR, Chanez P, Sibille Y, Pilette C. Asthma phenotypes and IgE responses. European Respiratory Journal. 2016;47(1): 304–319.10.1183/13993003.01824-201426677936Search in Google Scholar

10. Gauthier M, Ray A, Wenzel SE. Evolving concepts of asthma. American Journal of Respiratory and Critical Care Medicine. 2015;192(6): 660–668.10.1164/rccm.201504-0763PP544729326161792Search in Google Scholar

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