ABSTRACT
Case report Background: Aspergillus is a saprophytic mold that can cause a broad variety of pulmonary syndromes, categorized in three branches: allergic bronchopulmonary aspergillosis (ABPA), chronic pulmonary aspergillosis (CPA) and invasive pulmonary aspergillosis (IPA). Although these three pathologies involve damaged lung tissue and presence of Aspergillus, it is uncommon to find more than one of them in the same patient. In recent years, overlap of these syndromes is being recognized in some patients, primarily in those treated with immunosuppressive agents, such as long term use of corticosteroids. Case report: We report a case of a 54 year old woman diagnosed with ABPA in 2014, that, following treatment for her pathology with steroids and benralizumab (monoclonal antibody against interleukin- 5), developed IPA, that required hospital admission and treatment with antifungal agents. Since the diagnosis of ABPA, she had been treated with oral corticosteroids and antifungal agents in 2 occasions (2014 and 2017) and omalizumab (monoclonal antibody against IgE) in 2016. Omalizumab had to be discontinued after second administration due to flu-like symptoms, headache, joint and neck pain. In February 2020 due to lack of control of her illness with 15 mg oral prednisone daily, she initiated treatment with benralizumab, being hospitalized after the onset of this new medication as a result of an asthmatic exacerbation. Due to COVID pandemic, she reinitiated benralizumab in June 2020, and continued ever since the administration at home every 2 months in association with 7.5 mg oral Prednisone daily. Following clinical worsening of the patient, a thorax CT scan was performed in September 2021, where a nodule accompanied by a "halo" sign was visualized. The patient was admitted to hospital to start new treatment with higher dose of corticosteroids, antifungal therapy, supplementary oxygen and benralizumab was discontinued. Conclusion(s): To our knowledge, this is the first case of IPA secondary to ABPA in a patient treated with a monoclonal antibody and long term oral corticosteroids. Physicians should be aware of this possible overlap syndromes so that appropriate therapy can be instituted.
ABSTRACT
Background: The purpose of the study is to analyze the type of hypersensitivity reactions (HR) with Pfizer-BioNTech COVID-19 Vaccine (Comirnaty®) referred to our Allergy Department (AD), in order to asses vaccination with second dose safely. Method: Subjects with suspicion of HR after administration of first dose of Comirnaty® were referred to our AD from the Prevention and Occupational Risk Department responsible for the vaccination of hospital staff. Clinical history with special attention to atopic comorbidities and a detailed description of the HR after first dose of Comirnaty® was recorded. After providing signed informed consent, subjects underwent an allergy workup consisting of skin prick tests and intradermal tests (immediate and delayed readings) with polyethylene glycol (PEG) 4000 (1, 10 and 100 mg/ml), Polysorbate 80 (0.004 and 0.04 mg/dl), and Comirnaty® vaccine (as is). If skin tests proved negative, the second dose of Comirnaty® was administered under close supervision at our AD with an observation period of 60 minutes. Results: As of March 10, 2021, 6907 subjects had received the first dose of Comirnaty® and 5 were referred to our AD for evaluation. Mean age was 35 years, 4 were female and 1 male. Four patients had previous allergic history consisting of seasonal allergic rhinitis, contact dermatitis to nickel and thimerosal, and allergy to metamizole and mesalazine. After vaccination, two subjects had non-immediate reactions (NIR) that were generalized erythema within the first 48-96 h. Two subjects had immediate reactions (IR) 15 min after vaccination, consisting of generalized urticaria and erythema, and one was referred with a suspicion of immediate anaphylaxis but the reaction did not meet Brighton Anaphylaxis criteria. All subjects had negative skin tests with PEG-4000, Polysorbate 80 and Comirnaty®. The patient with the “suspicion of anaphylaxis” refused to receive the second dose. The remaining 4 subjects received the second dose of Comirnaty® with no reaction. Conclusion: The incidence of suggestive hypersensitivity reactions to Comirnaty® vaccine in our hospital staff was very low (0.07%). The administration of the second dose after a negative allergy workup seems safe, although the number of subjects treated is small.