Real-life efficacy and safety aspects of 4-year omalizumab treatment for asthma

Objective: To evaluate the long-term efficacy and safety of omalizumab in asthma in a real-life setting

Subjects and Methods: This 4-year observational study included 65 patients treated with omalizumab during clinic visits; treatment response was rated as excellent, good, and partial based on a modified physician's Global Evaluation of Treatment Effectiveness [mGETE] scale of emergency room visits [ERV], hospitalization, use of oral corticosteroids, inhaled corticosteroid [ICS]/long-acting Beta-agonist [LABA] dose, and short-acting Beta-agonist rescue. The following tests were done: forced expiratory volume in 1 s [FEV1] and the asthma control test [ACT]. Measurements were performed 1 month before therapy and at 16 weeks, 1 year, and 4 years of treatment. Statistical analyses were done using the Wilcoxon signed-rank test, Spearman rank correlation, and McNemar X[2] test

Results: The dropout rate was 15 [18.5%]: 8 nonresponders [10.0%]; 2 patients died [2.5%], and 5 were lost to follow-up [6.25%]. Treatment response was excellent in 35 [53.8%]; good in 23 [35.4%], and partial in 7 patients [10.8%]. The number of excellent responders increased from 35 [53.8%] at 16 weeks to 48 [73.8%] at the 4-year follow-up. The number of patients who did not require ERV improved from 0 to 59 [90.8%], and the lowest rate of hospitalization was 1 in year 4 [p < 0.001]; patients who did not require courses of oral corticosteroids improved from 0 to 54 [83%]. ICS/LABA dose significantly reduced from 65 [100%] to 25 [38.5%] after 4 years of treatment [p < 0.001]; ACT scores significantly increased from 15 +/- 3 at baseline to 23 +/- 3 [p < 0.001] and FEV[1] level from 55.6 +/- 10.6 to 76.63 +/- 10.34 at year 4

Conclusion: In this study, omalizumab therapy resulted in better asthma control, and was effective and well tolerated as an add-on therapy for patients with moderate-to-severe asthma

Penicillin allergy evaluation: experience from a drug allergy clinic in an Arabian Gulf Country, Kuwait

BACKGROUND: Hypersensitivity to penicillin has been studied worldwide, but data regarding patterns of sensitization in Arabian Gulf countries are scarce. OBJECTIVE: To describe the patterns of penicillin hypersensitivity during a 6-year study in Kuwait in terms of demographics, type of the culprit drug, in vivo and in vitro allergy testing. METHODS: One hundred and twenty-four patients referred to the drug allergy clinic for penicillin allergy were fully evaluated by skin prick and intradermal testing. Drug provocation test was done on patients with negative results. RESULTS: A total of 124 patients were evaluated for penicillin allergy. Mean age was 37.8 (standard deviation, 12.7) years, range from 8 to 74 years. Thirty-nine male (31.5%) and 85 female patients (68.5%) were included. Diagnosis of penicillin allergy was confirmed in 46 patients (37.1%). Among the 44 confirmed allergic patients by skin evaluation we had 15 (34.1%) positive skin prick test, and 29 (65.9%) positive intradermal testing. Among patients with positive skin testing, 47.7% were positive to major determinant benzylpenicilloyl poly-L-lysine, 20.4% to minor determinant mixture, 50.0% to penicillin G and 40.9% to ampicillin; 13.6% of patients were positive to amoxicillin by skin prick test. One patient had a positive radioallergosorbent test and one had a positive challenge test. CONCLUSION: Penicillin allergy is a common problem with an incidence of about one third in our study subjects.

Association and symptom characteristics of irritable bowel syndrome among bronchial asthma patients in Kuwait

Excess prevalence of irritable bowel syndrome in asthma has been reported, suggesting a link between those two conditions. To investigate the association between irritable bowel syndrome [IBS] and asthma, and explore the symptoms if IBS among asthma patients in Kuwait. Case control study. In a tertiary center, for allergy and asthma, 138 patients aged 20-65 years, with asthma, diagnosed clinically and by spirometry, were compared with 145 healthy, non-asthmatic controls matched for age, gender and nationality. Cases and controls completed at self-administered questionnaire of irritable bowel syndrome diagnosis [ROME II criteria]. The data were analyzed using SPSS software, and proportions were tested with Chi-square or Fisher's test. Odds ration [OR] with 95% confidence Interval [CI] were calculated to identify the associated risk factors. The demographic variables were selected for logistic regression analysis. A significantly large proportion [39.13%] of asthmatics had IBS as compared to 7.93% controls [P<0.001]. A higher proportion of females with IBS were observed in cases and controls [74%, 61.54%]. IBS was seen in 87% cases using inhalers, and in 13% with additional oral theophylline [P<0.001]. As many as 66.6% cases, had IBS with relatively short duration of asthma [1.5 years, P<000]. Predominant symptoms of IBS in asthmatics were abdominal discomfort or distension [64.8% vs. 11.5%], [P < 0.000, OOR = 14.1; 95% CI: 3.748 - 53.209] bloated feeling of abdomen [74.1% vs. 34.62% [P < 0.001, OR = 5.38; 95% CI: 1.96 - 14.84]], increased frequency of stools [63%, P < 0.006]. Irritable bowel syndrome in asthmatics was significantly high, more in the female asthmatics. Abdominal discomfort, persistent bloated feeling, increased frequency of passing stools were the most common IBS symptoms observed