R Divya, Venkitakrishnan Rajesh, Augustine Jolsana, Cleetus Melcy
Department of Pulmonary Medicine, Rajagiri Hospital Chunangamvely, Aluva, 683112, Kochi, Kerala, India.
Case Rep Pulmonol. 2020 Sep 14;2020:8898454. doi: 10.1155/2020/8898454. eCollection 2020.
Asthma is one of the most common respiratory diseases encountered in clinical practice. Although the vast majority of asthmatics can be adequately controlled with inhaled steroids and other preventer medications, a small proportion remain uncontrolled. Anti-IgE treatment with omalizumab has been proposed in patients as a preferred approach in step 5 asthma therapy according to GINA guidelines. Although therapy with this molecule is approved for patients with atopic asthma and pretreatment serum IgE levels of 30-1500 only, there have been a few reports of its efficacy in subjects outside this reference IgE range. We report the case of a middle-aged lady with severe corticosteroid-dependent asthma and low serum IgE levels who was successfully treated with 9 months of omalizumab therapy. She gained good asthma control and was tapered off steroid use by the fifth month of therapy with omalizumab. The case report stresses the need for further investigation into expanding the spectrum of omalizumab usage in asthma beyond the current IgE suitability range.
哮喘是临床实践中最常见的呼吸系统疾病之一。尽管绝大多数哮喘患者可以通过吸入类固醇和其他预防性药物得到充分控制，但仍有一小部分患者病情无法得到控制。根据全球哮喘防治创议（GINA）指南，对于这些患者，已提出使用奥马珠单抗进行抗IgE治疗作为哮喘治疗第5步的首选方法。尽管该药物仅被批准用于治疗特应性哮喘且治疗前血清IgE水平在30 - 1500的患者，但仍有一些报告称其在该参考IgE范围之外的患者中也有疗效。我们报告了一例中年女性患者，患有严重的依赖皮质类固醇的哮喘且血清IgE水平较低，接受了9个月的奥马珠单抗治疗并获得成功。在接受奥马珠单抗治疗的第5个月，她的哮喘得到了良好控制，并且逐渐减少了类固醇的使用。该病例报告强调需要进一步研究，以扩大奥马珠单抗在哮喘治疗中的使用范围，使其超出目前的IgE适用范围。
