Mepolizumab,severe asthma,FEV1,super-responders,eosinophilic asthma,eosinophil

Chronic rhinosinusitis whit nasal polyps (CRSwNP) is the most common comorbid disease accompanying asthma. Omalizumab is a recombinant anti-immunoglobulin (Ig) E antibody, and studies suggest that omalizumab may also affect CRSwNP regardless of asthma. We aimed to assess the effect of omalizumab treatment on CRSwNP accompanying severe allergic asthma (SAA) patients. Clinical data including spirometry measurements, serum/nasal secretion biomarker levels were collected. NP scores and CRS scores (Lund-Mancay [LM] scores) were also recorded before omalizumab treatment, as well as at the 4th and 12th months of omalizumab treatment. Twenty-one patients with both CRSwNP and SAA who underwent omalizumab therapy were assessed. There was a significant difference among forced expiratory volume (FEV1), ACT scores, NP scores, LM scores, serum IgE, and blood eosinophil levels of the patients before omalizumab therapy at the 4th and 12th months of omalizumab treatment. A significant negative correlation was observed between ∆FEV1 and ∆NP scores (r=−0.485), between ∆ACT and ∆NP scores (r=−0.469), and ∆ACT and ∆LM scores (r=−0.436). When we grouped the patients who benefited from 1 year of omalizumab therapy and those who did not in terms of NP, there was no difference between the two groups related to local eosinophil and local IgE levels in the nasal polyp biopsy. Omalizumab treatment is effective for asthma and CRSwNP in patients with CRSwNP accompanied by SAA. Improvement in asthma is associated with improvement in CRSwNP. The efficacy of omalizumab on NP in patients with CRSwNP accompanied by SAA is independent of local IgE and eosinophil counts.

Introduction: Nonatopic asthmatic patients generally have more severe clinical manifestations, frequently accompanied by chronic sinusitis and nasal polyps, with more limited therapeutic options as compared to atopic asthmatic patients. This has led to a search for novel therapeutic approaches, including omalizumab, for nonatopic asthmatic patients who are not adequately controlled with current therapies. Materials and Methods: In this retrospective study undertaken between August 1, 2020, and December 31, 2021, at a tertiary allergy clinic, data from 61 patients with nonatopic asthma inadequately controlled with optimum therapy was examined. Results: A total of 61 patients with severe asthma were included in the study [Female: 48 (78.7%), male: 13 (21.3%, mean age: 49 (18–71) years]. The mean duration of asthma was 60 (18–160) months. A statistically significant increase in Forced expiratory volume (FEV1per second), forced vital capacity (FVC), and asthma control test (ACT) scores were found after 1 year of omalizumab treatment (p ˂ 0.001, for all parameters). Omalizumab treatment was associated with a significant decrease in the number of asthma exacerbations, asthma-related hospitalizations, duration of hospitalizations, and several unplanned emergency room visits after 1 year (p ˂ 0.001, for all parameters). A 1-year treatment with omalizumab led to significant changes in eosinophil counts and serum IgE levels (p ˂ 0.001 and ˂ 0.001, respectively). Conclusion: In the severe atopic asthma patient group, omalizumab treatment provided similar clinical benefits to those observed in patients with severe atopic asthma, suggesting that it may be a useful therapeutic option in patients with nonatopic asthma who failed to benefit from treatments with steps 4 and 5.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a zoonotic virus which was first discovered in Wuhan, the People’s Republic of China in December 2019 and has led to one of the greatest pandemics of world history in a short period of time. SARS-CoV-2 is a rapidly spreading infectious disease with a high mortality rate. The disease has a moderate and severe course in approximately 20% of the patients and mortality reaches up to 62% among these patients . The majority of the patients develop SARS-CoV-2-induced pneumonia and manifestations of pneumonia rapidly progress to respiratory failure. The treatment of COVID‐19‐induced cytokine storm is not definitive, several pharmacological agents have been tried and used. Tocilizumab (TCZ) is a promising agent that is used for the treatment of cytokine storm. TCZ is an IgG1 class recombinant humanized monoclonal antibody against interleukin-6 (IL-6) receptor [4].However, potential IgE-mediated immunological reactions against this drug, especially anaphylaxis, may deprive these patients of an important treatment option for the treatment of COVID-19-induced cytokine storm. Although TCZ-induced anaphylaxis has been reported in the literature as case reports of indicated rheumatic diseases, TCZ-induced anaphylaxis has not yet been reported in patients using TCZ for PCR positive COVID‐19‐induced cytokine storms. In this case series, we aimed to represent cases of anaphylaxis which developed in two different patients using TCZ for COVID-19-induced cytokine storm.

Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Wuhan, China, it has been one of the largest pandemics in the history which has been aggressively spreading all over the world and affected more than 6 percent of world's population. In SARS-CoV-2 pandemics, patients with severe asthma require particular attention due to not only the underlying airway disease, but also immunomodulatory treatments used. Although it is known that viruses infecting the respiratory mucosa are risk factors for asthma attacks and that viral infections at early stage of the life are risk factors for development of asthma, and patients with a chronic disease have been declared as the risk group for severe SARS-CoV-2 infection by The Centers for Disease Control and Prevention (CDC), some studies reported that ratio of patients with asthma is relatively lower among the patients hospitalized for SARS-CoV-2. This suggests that treatments used for asthma may be protective against SARS-CoV-2. In addition, our knowledge regarding effect of omalizumab on mortality and morbidity in patients with asthma using omalizumab in SARS-CoV-2 infection is limited. In this case report, through reporting this first case of accompanying SARS-CoV-2 case in a patient with severe persistent asthma using omalizumab from Turkey, we aimed to discuss potential effects of omalizumab treatment on accompanying SARS-CoV-2 pneumonia in these patients.