Giavina-Bianchi Pedro, Giavina-Bianchi Mara, Agondi Rosana, Kalil Jorge
Division of Clinical Immunology and Allergy, University of São Paulo, São Paulo, Brazil.
Int Arch Allergy Immunol. 2007;144(2):155-8. doi: 10.1159/000103228. Epub 2007 May 29.
Treatment of the Churg-Strauss syndrome (CCS) remains a challenge. Many patients relapse after achieving remission, and a substantial proportion of them present adverse drug reactions with relevant morbidity. In most patients, severe asthma and upper respiratory symptoms persist, requiring continuous therapy. The aim of the present study is to describe a patient with CSS who was administered anti-IgE.
A 46-year-old male patient with CSS followed up for 17 years is described. Upon treatment, CSS showed remission but asthma failed to improve despite high-dose inhaled corticosteroids, long-acting beta2-agonists and several courses of systemic steroids. In order to better control asthma, anti-IgE was administered. Following omalizumab administration, asthma symptoms (according to clinical features and lung function tests) and eosinophilia improved.
Anti-IgE offers the potential not only to decrease asthma activity but also to reduce the risk of morbidity that can result from currently available treatment options. Whether it can also affect the activity of other CSS components is an open question. As far as we know, there are no published reports about the prescription of omalizumab to patients with CSS and with non-allergic asthma. Anti-IgE improved our patient's asthma and decreased the eosinophil blood count but did not worsen the outcome of CSS. However, large and long-term studies are necessary before a more widespread utilization of anti-IgE in CSS patients can be implemented.
变应性肉芽肿性血管炎（CSS）的治疗仍然是一项挑战。许多患者在病情缓解后复发，并且其中很大一部分出现具有相关发病率的药物不良反应。在大多数患者中，严重哮喘和上呼吸道症状持续存在，需要持续治疗。本研究的目的是描述一名接受抗IgE治疗的CSS患者。
描述了一名随访17年的46岁男性CSS患者。治疗后，CSS病情缓解，但尽管使用了高剂量吸入性糖皮质激素、长效β2受体激动剂以及多个疗程的全身用糖皮质激素，哮喘仍未改善。为了更好地控制哮喘，给予了抗IgE治疗。使用奥马珠单抗后，哮喘症状（根据临床特征和肺功能测试）及嗜酸性粒细胞增多情况有所改善。
抗IgE不仅有可能降低哮喘活动度，还能降低现有治疗方案可能导致的发病风险。它是否还能影响CSS其他成分的活动仍是一个悬而未决的问题。据我们所知，尚无关于给CSS合并非过敏性哮喘患者开具奥马珠单抗处方的报道。抗IgE改善了我们患者的哮喘症状并降低了嗜酸性粒细胞计数，但并未使CSS病情恶化。然而，在CSS患者中更广泛地使用抗IgE之前，还需要进行大规模的长期研究。
