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Objective: The effect of biological agents used in severe allergic diseases on the risk of coronavirus disease 2019 (COVID-19) and the course of the disease still remains unclear. The aim of the study was to evaluate retrospectively the frequency and severity of COVID-19 to determine risk factors and to present real-life data in patients using biological agents.Materials and Methods: Patients who have used omalizumab or mepolizumab for at least six months were questioned retrospectively in terms of a history of COVID-19. Patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction (PCR) or serological IgG positivity, symptoms, lung involvement, the need for supplemental oxygen, hospital and intensive care admission, and mortality were queried. Results: Of the 71 patients (omalizumab/mepolizumab: 51/20) included in the study, the average age was 37.2 +/- 12.9, and the female/ male ratio was 46/25. Of the 11 patients (omalizumab/mepolizumab: 6/5) with SARS-CoV-2 positivity, two were hospitalized for pneumonia and needed oxygen. However, intensive care was not required and they survived. There was no significant difference between mepolizumab users who had COVID-19 and those who did not in terms of baseline and post-treatment 6th-month eosinophil values (p= 0.7, p= 0.59, respectively). It was established that eosinopenia developing after treatment did not increase the risk of COVID-19 in patients using mepolizumab [RR (95% Cl) 0.99 (0.97-1.02), p=0.88].Conclusion: According to our single center data, we found the risk of severe COVID-19 in patients using biological agents to be quite low. Especially, eosinopenia that developed after mepolizumab treatment did not constitute a risk factor for the severity of COVID-19.
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Case report Introduction: Various immediate or delayed types of cutaneous adverse reactions such as local site reaction, urticaria, mobilliform rash, elayed large local reactions, etc. have been noted after COVID-19 vaccination, which were usually treatable with times. Here we report 13 patients with chronic spontaneous urticaria (CSU) developed after COVID-19 vaccination. Cases: Of the 13 CSU patients, four were male and mean age was 42+/-9 years (range: 28-56). Twelve patients were vaccinated with Pfizer-BioNTech COVID-19 vaccine, and one was with Oxford/ AstraZeneca vaccine. 7 patients (53.8%) were developed CSU after their first vaccination, 5 patients (38.5%) were after 2nd booster shot, and one (7.7%) were after third booster shot. Mean latent period was 7+/-6 days (range: 1-20). Mean duration of CSU were 22+/-8 weeks. Nine patients (69.2%) who refractory to 3-or 4-fold increase of H1-antihistamines took omalizumab treatment, all of whom reached well-or completely controlled status. Five of them (55.6%) achieved well-controlled status within 1 month, while 4 of them achieved well-controlled after 3 months. 1 of them took cyclosporine in addition to 300mg/4 weeks to reach well-controlled status. Conclusion(s): COVID-19 vaccination can be a cause of CSU. CSU after COVID-19 vaccination can be intractable to treatment with 4-fold increase of H1-antihistamines. Omalizumab works well to control CSU after COVID-19 vaccination.
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Background: Although there are case reports and guideline recommendations that states omalizumab can be used in chronic spontaneous urticaria (CSU) patients during SARS-CoV- 2 pandemic, there are scarce studies showing the course of Coronavirus disease 2019 (COVID-19) in CSU patients receiving omalizumab. Method(s): A total of 370 patients with chronic urticaria were included in the study between June 2020 and December 31, 2020. Result(s): Sixty patients (16.2%) became infected with the SARS-CoV- 2. The rate of pneumonia and hospitalization were 4.1% and 1.9%. There was no significant difference was determined between the CSU patients with omalizumab treatment and the non-receivers in regard to the rate of SARS-CoV- 2 (+) (p: 0.567) and in regard to the rate of SARS-CoV- 2 related pneumonia and hospitalization (p: 0.331 and p: 0.690). Gender, duration of CSU, serum IgE levels, omalizumab treatment, and atopy were not found to be associated with an increased risk for SARS-CoV- 2 positivity in patients with CSU. Conclusion(s): Our study shows that the use of omalizumab does not increase the risk of COVID-19 infection, COVID-19- related pneumonia and hospitalizations in CSU patients and supports the views that omalizumab can be used safely in patients with CSU during the COVID-19 pandemic.
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Case report Background: Association of chronic spontaneous urticaria (CSU) with malignancies and worsening of urticaria during COVID-19 have been reported. The efficacy of treatment of CSU with omalizumab in the context of malignancies or COVID-19 is not well established. Method(s): Case report of a patient followed for 9 years with CSU. Data collected from Medical Records and interviews during consultations. Result(s): Female, 29 years-old, came to clinic in 2013 for investigation, diagnosed with CSU. She also presented mild asthma, allergic rhinitis and history of urticaria after taking amoxicillin. She had a positive autologous serum skin test, and positive skin tests to dust mite, cat, cockroach, peanut and milk. Her total IgE was 227IU/ mL. Anti-nuclear and anti-thyroid antibodies were negative;ERS 13mm, blood eosinophils 300/mm3, and stool exam negative for parasites. She showed no response to second generation antihistamines up to fourfold doses, with UCT < 6 and CU-QoL = 89. After 6 months, omalizumab was added at 300 mg subcutaneously, every 4 weeks. The patient showed immediate reactions after the two applications of omalizumab: first, diffuse pruritus and throat tightness;second, worsening of urticaria and pruritus, requiring iv medications. Treatment with omalizumab was stopped, she was kept on fourfold dose of bilastine with partial control of symptoms. In 2016, she presented worsening of urticaria (UCT = 1), weight loss of 6kg/2 months, daily fever and enlarged cervical lymph nodes, and was diagnosed with diffuse large B-cell non-Hodgkin's lymphoma. Following chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone and rituximab, she presented complete resolution of urticaria. Two years after remission of the lymphoma, in 2019, she presented recurrence of urticaria, and treatment with fourfold dose of bilastine was reinitiated with control of symptoms (UCT = 16). Investigation ruled out recurrence of lymphoma. In May 2021, she was diagnosed with SARS-CoV- 2 infection. Symptoms of COVID-19 were runny nose and low grade fever, however urticaria got worse and no longer responsive to bilastine. Treatment with omalizumab was attempted, with no reactions and good efficacy after the first dose, with an UCT = 15, and urticaria remains controlled on treatment with omalizumab to present. Conclusion(s): In this report, we highlight the efficacy and safety of using omalizumab in a patient with refractory CSU associated with neoplasia and SARS-CoV- 2 infection.
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Background: Little is known about the course of COVID-19 in patients with severe asthma/chronic spontaneous urticaria (CSU) using biological agents. To assess the incidence and course of COVID-19 in patients with severe asthma/CSU using biological agents Method: A total of 202 patients (142 with asthma, 60 with CSU) were enrolled. The subjects were questioned via face-to- face or telephone interview whether they had been diagnosed with COVID-19 and the course of the disease. Result(s): Study group consisted of 132 women, 70 men (median age: 48 years). Thirty-one (15.3%) patients were diagnosed with COVID-19, 22 (71%) of whom were receiving omalizumab and 9 (29%) were receiving mepolizumab. Diagnosed with asthma or CSU, age, sex, smoking, weight, comorbidities, atopy and receiving biological agent were not statistically different between patients with or without COVID-19. Nine COVID -19 patients were hospitalised, three of them required intensive care. Mepolizumab usage was higher in hospitalised patients (5, 55.6%), whereas omalizumab usage was higher in home-treated patients (18, 81%). The mean duration of biologicals usage in home treated patients was significantly higher than that of the hospitalised patients (35.64 months vs.22.56 months, p = 0.024). Biological treatments were interrupted in 47 (23%) patients, self-interruption due to the infection risk was the foremost reason (34%) while having COVID-19 took the next place (28%). Conclusion(s): The incidence of COVID-19 among patients with asthma and CSU on mepolizumab and omalizumab was higher compared to studies from other countries. The disease course appeared mild in patients receiving long-term biological therapy.
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Background: Covid 19 is a global epidemic. One of the most important steps in the fight against this epidemic is vaccination. mRNA vaccines are used in vaccination in our country. Among the additives in the vaccine, the substance with the highest allergenic risk is polyethylene glucose (PEG). There are different molecular weights of PEG. Another additive that has a high risk of cross-reaction with PEG as an additive is POLISORBAT 80. Skin tests with drugs containing PEG and POLISORBAT 80 and, if available, tests with vaccines are instructive. Among the drugs containing PEG: Moxifloxacin tablet, ciprofloxacin tablet, Amoxicillin clavulanic acid tablet;Medicines containing polysorbate include: Omalizumab vaccine, Mepolizumab vaccine. The results of the skin test with PEG-containing methylprednisolone (DEPO-MEDROL) and POLYSORBAT-containing triamcinolone (KENACORT-A) in order to be evaluated in terms of vaccine in our 2 patients who had multiple drug sensitivities before were shared. Method(s): Case 1: 33 y, F *There are diagnoses of urticaria and angioedema. Urticaria 30 minutes after taking aspirin, levofloxacin, cefdinir tablet;5 minutes after taking ciprofloxacin tablets, he has anaphylaxis. *Applies before Biontec vaccine. *The patient had a history of anaphylaxis with PEG-containing ciprofloxacin. In the skin tests performed with DEPO-MEDROL and KENACORT-A, 1/100 intradermal test was positive. *The patient for whom Biontec vaccine was not recommended received Synovac vaccine without any problems. Case 2: 52 years, F * He has a diagnosis of urticaria. 5 minutes after general anesthesia and local anesthesia;The patient who had cardiac arrest 3 times was evaluated. The patient, who had Synovac for 2 times without any problems, wanted to have the 3rd dose of Biontec vaccine. *Tested with general -local anesthetic agents. *Ciprofloxacin skin tests are negative;Urticaria plaques developed after 30 minutes of 1/4 tb in oral provocation. In the skin tests performed with DEPO-MEDROL and KENACORT-A, 1/100 intradermal test was positive. *Biontec vaccine is not recommended. Result(s): A safer vaccination is ensured by testing with additives in Covid 19 vaccines. Conclusion(s): Drug additives should also be kept in mind in patients with multiple drug allergies.
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Background: The 2021 EAACI Biological Guidelines note safety of omalizumab use during rhinovirus infections, but data on initiation of this biologic therapy for patients with resistant chronic spontaneous urticaria (rCSU) during the SARS-CoV- 2 pandemic and uptake of COVID-19 vaccination are scarce. This study evaluated: 1) safety of omalizumab initiation and continuation during the pandemic;2) rate of COVID-19 positivity in patients on omalizumab therapy and 3) COVID-19 vaccine uptake among patients on biologic therapy. Method(s): A department-held database identified patients who started omalizumab for rCSU between 1 March 2020 and 31 December 2021, and those who contracted COVID-19 infection and their vaccination status. Result(s): Forty-one patients (median age 42 years, 85% females) with rCSU (baseline UAS7 > 28) were started on omalizumab therapy (300mg subcutaneous once every 28 days, 6 doses/cycle), and 17 (41%) were transferred to home care. A total of 316 doses were used with no anaphylaxis events. Nineteen patients had excellent response (UAS < 6) and remained on treatment (53% patients on 2nd cycle), including two patients now on 4th cycle having required almost continuous biologic therapy. A total of 22 patients had stopped omalizumab, 14 having responded to therapy (12 patients had complete response in cycle 1 and two patients in cycle 2) while 8 patients were non-responders (20% overall non-responders;7 patients within cycle 1 and one in cycle 2). Seven patients (17%) tested positive for SARS-CoV- 2 (PCR) whilst on omalizumab therapy, but none had severe illness or required hospitalisation. 90% of patients had at least 1 dose of COVID-19 vaccine, while 27 patients (66%) had 3 doses (2 primary and 1 booster). All patients deferred omalizumab for a week after COVID-19 vaccination. Ninety-eight vaccine doses were given including 64 doses of BNT162b2 mRNA (Pfizer-BioNTech) vaccine, followed by AstraZeneca at 33 doses and 1 dose of Moderna vaccine. One patient had worsening of severe urticaria after first dose of AZ vaccine, and refused further vaccines, subsequently contracted SARS-CoV- 2 whilst on omalizumab therapy. Yet another patient who was never vaccinated having stopped omalizumab after complete response (2nd cycle), subsequently tested positive for SARS-CoV- 2 but did not report relapse of urticaria. Conclusion(s): Omalizumab therapy was safe and effective in rCSU and none of the patients who contracted SARS-CoV- 2 on the biological therapy developed severe illness. (Table Presented).
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Background: COVID-19 is an infectious entity caused by the SARS-CoV-2 virus. There have been reported risk factors like chronic airway entities such as chronic obstructive pulmonary disease. Since asthma is a respiratory disease, it could be found as a risk factor to develop severe COVID-19 disease. However, most of the evidence reveals that asthma isn't associated with higher severity or worse prognosis. Madrid has been one of the most affected regions in the world during the pandemic. La Paz University Hospital has developed one of the largest cohorts in Europe. We used this data and described several characteristics around COVID-19 disease in asthma patients. Method(s): We collected data by individual review of the patients' electronic clinical records (DXC-HCIS, Healthcare Information System). Then we describe the general characteristics of the patients, their asthma, and COVID-19 evolution. The analyzed data includes general demographics, asthma classification (T2 or no T2), basal treatment, and pre-COVID-19 asthma control (by ACT and exacerbations). We studied acute COVID-19 disease symptoms and treatment, the presence of pneumonia, thromboembolism, the need for hospitalization, admission to the intensive care unit (ICU), and mortality. Result(s): The total number of patients studied was 173, the majority were women (67%) with an average age of 55 and type 2 asthma (67%) which was controlled before COVID-19 disease (ACT median was 25, the median of exacerbations was 0). The majority used the combination of long-acting beta 2 agonists and inhaled corticosteroids (ICS+LABA) for asthma treatment (67%). Only 2 patients were treated with omalizumab, which was discontinued during COVID-19 disease. The most frequent symptoms were cough and dyspnea (80% and 75% respectively). 4% of patients presented thromboembolism. 60% had pneumonia. 60% required hospitalization, 11% of whom died due to COVID-19 complications. The most common treatment was hydroxychloroquine and azithromycin (75% and 45% respectively), followed by oral corticosteroids (15%), lopinavir/ritonavir (8%), tocilizumab (5%), and remdesivir (2%). Conclusion(s): This cohort represents asthmatic patients in La Paz University Hospital. We observed that the proportion of hospitalizations, ICU admissions, and mortality due to COVID-19 was similar as described in previous studies and therefore no different from non-asthmatic patients. The characteristics presented in this study help us better understand the complications of asthmatic patients thanks to one of the largest COVID-19 cohorts in Europe.
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Background: One of the most disadvantageous group of people in Covid 19 pandemic are those with chronic diseases who have been unable to reach medical services they should have. The aim of our study was to investigate if our patients receiving either subcutaneous allergen immunotherapy (SCIT) or biologicals had been effected in terms of compliance to their treatment. Method(s): All of our patients that were being followed in our outpatient clinic receiving a regular treatment -either SCIT or a biological agent -before January 2020 were included in the study. The study group consisted of a total of 223 adult patients of whom 128 were on SCIT and 95 on a biological agent. We applied a conversation based survey to each patient by means of a phone call or during an office visit to identify any disruption in their treatment. We also screened our patient files to collect demographic data and data related to the diagnosis and duration of therapy. Patients were also asked if they had past Covid -19 infection or not. Result(s): Out of 128 patients receiving SCIT for an aeroallergen or venom,124 patients (median age 38 (min-max 18-66)) could have the survey completed. Eighty one patients (63.3%) reported that they couldn't continue their treatment while 43 (37.6%) patients could. The most common reasons of noncompliance were the reluctance of patients to go to the hospital with the fear of getting Covid 19 infection (n = 36 ;44.4%) and the difficulties in supplying the allergen immunotherapy product (n = 15;18.5%). Fourteen patients (17.3%) left the treatment as they were already close to the end of the scheduled treatment duration. Ninety one patients (median age 53 (min-max 19-75)) out of 95 who were on a biological treatment-either omalizumab or mepolizumab-had completed the survey. Only nine patients (9.9%) left the treatment while 82 patients (90.1%) did not. The most common reason for noncompliance was similarly the reluctance to go to the hospital in 4 (4.4%) of the patients . Twenty one of the SCIT patients (16.9%) and 22 patients (24.2%) receiving biologicals had documented Covid 19 infection. Conclusion(s): Covid 19 pandemic had a negative effect on our patients'compliance to their treatment. This effect was apparently higher in the patients receiving SCIT who should have their shots only in an allergy clinic under close supervision while patients on biologicals may receive their treatments in other healthcare centers.
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Background: The use of biologics during the pandemic has raised concerns throughout the scientific community. The current guidelines suggest continuing the use of biologics during the pandemic, while the initiation or continuation of treatment in case of symptomatic disease are remaining controversial unanswered questions. As a result the purpose of this study was to determine the frequency of symptomatic COVID19 infection in patients treated with biologic agents in an Allergy Unit of a University Hospital during the pandemic. Method(s): Patients of the Allergy Unit "D Kalogeromitros", who due to asthma, atopic dermatitis, Chronic Spontaneous Urticaria(CSU) or Chronic Rhinosinusitis with Nasal Polyps (CRSwNP)were under treatment with biologic agents were included in the present study. Treatment of at least 2 months until the 31/12/2021 was necessary for a patient to be included in the present study. Result(s): A total of 77 patients [46 (59.7%) women, mean age 48.2 (range 15-82) years were included. The mean duration of treatment with biologics was 34.9 months (SD: +/-37 months). Overall, 83.1% (64/77) of patients were receiving omalizumab for asthma and CSU [13/64 (20.3%) and 51/64 (79.6%) respectively] while 9.1% (7/77) were receiving dupilumab for atopic dermatitis (4/7) and CRSwNP [4/7 (57.1%) and 3/7 (42.8%) respectively]. In addition, 5/77 (6.5%) and 1/77 (1.2%) were under treatment with mepolizumab and one with benralizumab respectively, due to severe uncontrolled asthma. A total of 6 patients with chronic spontaneous urticaria and 2/19 patients with asthma (1/5 with mepolizumab and 1/13 with omalizumab) had symptomatic COVID 19 infection as confirmed with a positive Polymerase Chain Reaction or Rapid Test. None of the patients treated with benralizumab or dupilumab had symptomatic COVID19 infection. Overall, 8/77 (10.3%) of patients had symptomatic SARS-CoV2 infection during the above period, a rate similar to the onein the same period identified in the general Greek population (11.2%). All patients had mild symptoms during the disease course with no patient admission to hospital. Conclusion(s): The frequency of symptomatic COVID19 infection identified in a population of Greek patients treated with biologic agents was no higher than than the one in the general Greek population. Furthermore, all patients had a mild course of the disease with no admissions, indicating that the use of biologics is a safe choice and can be continued during the pandemic.
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Background: W e w ould l ike t o s hare o ur c linical o bservations r egarding the incidence of Covid-19 in our chronic urticaria and asthma cases receiving omalizumab. Method(s): In our clinic, omalizumab treatment is given to a total of 23 patients, 13 with the diagnosis of chronic spontaneous urticaria (CSU) and 10 with the diagnosis of asthma. Although the mean age of our patients who received omalizumab for CSU was 17.4;10 (77%) were female and 3 (23%) were male. One of these patients, a 20-year- old girl, was found to have a positive PCR test for SARS-CoV- 2 and was treated with omalizumab during SARS-CoV- 2 infection. Our patient had a SARS-CoV- 2 infection with mild symptoms at home without using any other medication. The mean age of our patients who received omalizumab for asthma was 16.5 years. 6 (60%) of our asthma patients were male and 4 (40%) were female. SARS-CoV- 2 PCR test was detected in a 20-year- old female patient who received omalizumab with the diagnosis of moderate-severe asthma, and this patient had a SARS-CoV- 2 infection with mild symptoms without needing any medication, staying in isolation at home. Result(s): 2/23 (8.7%) of our patients who received omalizumab treatment had SARS-CoV- 2 infection with mild symptoms at home. We think that omalizumab treatment is not a treatment that will only cause comorbidity during the Covid-19 pandemic. We continue to apply omalizumab treatment to our patients without causing any worries. We fully agree that our results show that cases taking omalizumab for CSU or asthma are not at greater risk of contracting SARS-CoV- 2 infection than the general population and provide further support for the safety of omalizumab use during the COVID-19 pandemic. Conclusion(s): Even if they were infected, the course of the COVID-19 disease in our cases did not seem different from the general population. While using omalizumab, data on the course of COVID-19 in these diseases continue to increase day by day. However;We should be aware that severe cases of COVID-19 should be given extra attention when using omalizumab as recommended.
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Background: There is no evidence clearly defining whether the administration of immunomodulatory biologic agents to allergic patients affects their immune response to COVID-19 infection. The current guidelines suggest the continuation of their use in patients who are not infected, while the continuation is individualized in the case of symptomatic disease. We sought to determine the cumulative incidence of symptomatic COVID-19 infection among chronic urticaria (CU) Greek patients, who, until 2/2/2021, were under omalizumab for at least two months. This was the date on which no Greek citizen was considered fully immunized due to vaccination against SARS-CoV- 2. Method(s): The present study extracted data from the first national multicenter registry of patients in Greece with chronic urticaria (GREEk National Urticaria Registry, GREENUR). All patients with CU under omalizumab during the pandemic, and the clinical characteristics of those with COVID-19 symptomatic infection, were recorded. Result(s): 329 patients were included (223 with CSU alone). Only 10/329 (6 women) or 3% had symptomatic COVID-19 infection confirmed by Polymerase Chain Reaction (PCR) analysis. Overall, 6 patients reported fever (up to 39.5degreeC), 5 rhinitis, 3 cough, one of which reported shortness of breath controlled with bronchodilation, 5 hyposmia/anosmia and ageusia, 8 muscle weakness, 5 arthralgia/ myalgia, and 7 headache. None of the patients was admitted to the hospital. According to the Centers for Disease Control and Prevention (CDC), only 1 in 4.2 cases of COVID-19 is being examined, of which 84% are symptomatic. Consequently, the cumulative incidence of symptomatic COVID-19 infection in the general Greek population on 2/2/2021 (number of confirmed cases on that date: 158,716) was estimated at 5.2%, significantly higher than that among patients with CU (p-value = 0.02). Conclusion(s): The cumulative incidence of symptomatic COVID-19 infection among patients with CU under omalizumab treatment is lower than that of the general population. All infected patients had a mild course and short duration of the disease and did not need hospitalization. These findings demonstrate not only the safety but also a protective role of omalizumab in patients with CU during the COVID-19 pandemic.
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Background: The real-world management and clinical characteristics of chronic spontaneous urticaria (CSU) in Hong Kong, and its implications for COVID-19 vaccination are unknown. We investigated the patient characteristics, effectiveness of an immunologist-led Urticaria Clinic, and the impact of CSU on COVID-19 vaccine uptake in Hong Kong. Method(s): Longitudinal clinical data of 257 CSU patients attending our immunologist-led Urticaria Clinic were analysed. Result(s): Most patients had experienced wheals (98.8%) and 65.4% had angioedema. 1.2% of CSU patients had angioedema without wheals. Two-thirds (66.5%) received inappropriate treatment prior to immunologist review. A significant proportion of patients had concomitant autoimmunity (14.8%) and history of suspected drug allergy (9.7%) respectively. Weekly Urticaria Activity Score (UAS7) was significantly lower after immunologist review (12.0 vs 0.00, p < 0.001). The change in UAS7 was significantly greater among patients with baseline UAS7 >=16 (-24.0 vs -2.00, p < 0.001);and, among those with uncontrolled disease despite second-line treatment, with access to omalizumab and/or ciclosporin (-26.0 vs -3.50, p < 0.001). Majority of patients received at least one (68.5%) and two doses (65.0%) of COVID-19 vaccine respectively. History of suspected drug allergy was associated with lower COVID-19 vaccine uptake (odds ratio: 0.47, p = 0.010). Conclusion(s): CSU patients in Hong Kong have unique clinical characteristics and a considerable proportion had received inappropriate treatment before immunologist review. An immunologist-led Urticaria Clinic was effective in CSU management. COVID-19 vaccination rates were lower than the general population in Hong Kong, and a history of suspected drug allergy was associated with lower COVID-19 vaccine uptake.
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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.
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Background: Patients with severe asthma (SA) may be at higher risk of severe COVID-19 (C-19) illness. C-19 vaccines aim to reduce number and severity of infections. Patients with SA are often treated with maintenance oral corticosteroids (mOCS) and/or biologics (mAb)- it is unknown if vaccines will generate the same protective responses in patients with SA on such therapies. Aim(s): To compare magnitude and range of post-vaccination (PV) antibody responses (IgG) in patients with SA on mAb, mOCS or high-dose inhaled corticosteroids (ICS) with healthy controls (HC) without asthma. Method(s): The Virtus finger-prick quantitative C-19 antibody test was used to detect IgG levels 16-24 weeks post second-dose of the C-19 vaccine (123 AstraZeneca, 56 Pfizer, 5 Moderna). IgG>0.2AU was considered positive with range: very high >1.25AU, high 0.751-1.25AU, medium 0.401-0.75AU and low 0.201-0.4AU. SA was defined as per ATS/ERS criteria. Result(s): PV IgG results were obtained from 127 patients with SA (84 mAb, 13 mOCS and 46 ICS) and 57 HC. After adjusting for age, significantly fewer people with SA compared to HC had a positive PV IgG result (81% vs 95% p=0.016). Lower median IgG levels were seen in patients on mOCS (0.40AU) compared to HC (1.24AU) (p=0.051). Patients on mAb had high or very high IgG levels (omalizumab n=25, 0.80AU;mepolizumab n=25, 1.07AU;benralizumab n=34, 1.11AU). Conclusion(s): Overall, a higher proportion of patients with SA had a negative PV IgG level after receiving 2 doses of a C-19 vaccine. This was mainly seen in patients on mOCS while mAb use was associated with high levels of humoral antibody response. These results reinforce the need for booster vaccines in SA, especially in those on mOCS.
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Introduction: The use of biological therapy in eosinophilic and atopic asthma has grown exponentially over the last 14years. Treatment was initially hospital-based, but the COVID-19 pandemic has accelerated the implementation of patient homecare self-administration (HSA) of biologics. Aim(s): To assess the stability of patients transfered on HSA by comparing data from biologic initiation to HSA discharge and annual review. Result(s): This report includes 56 patients who attended for annual review between April and December 2021 (60% female, mean age 54 [SD13.4]) for Benralizumab (42.9%), Mepolizumab (35.7%) and Omalizumab (21.4%). The time on biologic when commencing HSA was 19 (IQR 21.8) months, with an annual review 12 (IQR 8.3) months later. Previously obtained improvements in asthma control, lung function, eosinophil suppression and oral corticosteroid use, were maintained in 53(95%) of the patients (Table 1). HSA was stopped in 3(5%) patients due to deterioration in asthma control. Conclusion(s): The vast majority of patients recieving HSA of biologics maintained previous improvements across asthma outcomes, thereby strongly supporting the use of HSA in the correctly identified patient, consequently optimising service capacity. Appropriate monitoring arrangements are still needed to promptly identify any deterioration. (Table Presented).
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BACKGROUND AND OBJECTIVE: Chronic rhinosinusitis with nasal polyps (CRSwNP), characterized by partial (hyposmia) or total (anosmia) loss of smell, is commonly associated with asthma and/or nonsteroidal anti-inflammatory drug-exacerbated respiratory disease (N-ERD), worsens disease severity and quality of life. Objectives. The objective of this study was to determine whether, in real-life conditions, biological treatments prescribed for severe asthma can improve olfaction in patients with CRSwNP. A further objective was to compare smell improvement in N-ERD and non-N-ERD subgroups. METHODS: A multicenter, non-interventional, retrospective, observational study was performed, including 206 patients with severe asthma undergoing biological treatment (omalizumab, mepolizumab, benralizumab, or reslizumab) with CRSwNP. RESULTS: Improved olfaction was found after treatment with all monoclonal antibodies: omalizumab (35.8%), mepolizumab (35.4%), reslizumab (35.7%), and benralizumab (39.1%), with no differences between groups. Patients with atopy, greater use of short course systemic corticosteroids, and larger polyp size were more likely to experience improvement in smell. The proportion of patients experiencing smell improvement was similar between the N-ERD (37%) and non-N-ERD (35.7%) groups. CONCLUSION: This is the first study to compare real-life improvement in sense of smell among patients undergoing long-term treatment with omalizumab, mepolizumab, reslizumab, or benralizumab for severe asthma and associated CRSwNP. Approximately 4 out of 10 patients reported a subjective improvement in sense of smell (with non-significant differences between biologic drugs). No differences were found in smell improvement between the N-ERD and non-N-ERD group.
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Rationale: To seek optimal dosing regimens for Oral immunotherapy (OIT). Methods: A retrospective chart review of 93 patients undergoing "bite proof” nut OIT dosing was undertaken. Patients were escalated to doses of 250-500mg of nut protein for a 6-12 month period and then completed a 2gm nut challenge. Results: Among 93 patients, a total of 209 2g Nut Oral Food Challenges (OFCs) were conducted. 202 of the 209 administered 2g OFCs were passed (96.65%). Among the 6 patients who did not tolerate the initial 2gm OFC, there were no obvious differentiating characteristics identified including single vs multiple food OIT administration, age, concomitant omalizumab, or change in IgE levels from baseline. 12 of the 93 patients who successfully passed the 2gm challenge elected to reduce their dose to the bite proof dosing 3x weekly. 7 of these 12 patients completed a subsequent 2gm OFC 1 year after the initial OFC. All 7 patients successfully tolerated the second 2gm OFC. Conclusions: Patients undergoing a 6-12 month course of 250-500mg daily nut protein dosing exhibited robust success in passing a 2gm OFC. Defining characteristics of patients who failed initial 2gm OFCs could not be determined due to the small number of OFC failures. A subset of patients passing the 2gm OFC demonstrated continued success in tolerating a 2gm nut challenge following a decrease in dosing frequency. Unfortunately the COVID pandemic prohibited further OFCs study of such patients. Future studies of such patients will help elucidate ideal long term OIT dosing strategies.
ABSTRACT
BACKGROUND: The course of chronic spontaneous urticaria (CSU) can be influenced by infections, depression, and stress. OBJECTIVE: Our aim was to investigate the impact of the COVID-19 pandemic on the course of refractory CSU together with patient adherence to omalizumab and treatment adjustments. METHODS: Urticaria Activity Score (UAS7) was used to assess disease activity. Fear of COVID-19 Scale (FC-19s), and Depression Anxiety Stress Scale (DASS-21s) were performed to assess mental health status. All scales were performed during the Quarantine Period (QP) and Return to the Normal Period (RTNP). UAS7 Before Pandemic (BP) was recorded from the patients medical records. RESULTS: The authors evaluated 104 omalizumab-receiving CSU patients. UAS7 scores during QP were significantly higher than those in RTNP and BP (p < 0.01). DASS-21 and FC-19 scores were significantly higher during QP compared to RTNP (p < 0.01). Nineteen (18.2%) patients ceased omalizumab, 9 patients prolonged the intervals between subsequent doses during the pandemic. UAS7 scores in QP were significantly higher in patients who ceased omalizumab than in those who continued (p < 0.001). Among patients who continued omalizumab, 22.4% had an increase in urticaria activity and higher FC-19 scores in comparison with those with stable disease activity (p = 0.008). STUDY LIMITATIONS: The small sample size of patients with prolonged intervals of omalizumab and the lack of mental health evaluation with the same tools prior to the study. CONCLUSION: Fear induced by COVID-19 can determine an increase in disease activity. Therefore, patients on omalizumab should continue their treatment and prolonged interval without omalizumab can be considered in patients with good urticaria control.
Subject(s)
Anti-Allergic Agents , COVID-19 , Chronic Urticaria , Urticaria , Humans , Omalizumab/therapeutic use , Anti-Allergic Agents/therapeutic use , Pandemics , Treatment Outcome , Chronic Disease , Chronic Urticaria/drug therapy , Urticaria/drug therapyABSTRACT
Background: As COVID-19 vaccines continue to be administered worldwide, there are an increasing number of studies documenting cutaneous reactions following vaccination. Systemic reactions, such as urticarial diseases, occur. Purpose(s): The main objective of this study was to investigate the association between urticaria and recent vaccination for COVID-19. Method(s): A retrospective chart review examining the association of urticaria and COVID vaccination was conducted. Result(s): We report 17 patients who developed an urticarial reaction following vaccination against COVID and one patient who developed an urticarial reaction following a COVID infection. The vast majority of the patients were women with a mean age of 42.8 years. Conclusion(s): Cutaneous manifestations often follow COVID vaccination and infection. It may be helpful to inquire about recent infections and vaccinations in patients presenting with urticarial diseases. Copyright © 2022 Journal of Dermatology and Dermatologic Surgery.