Cortes-Telles Arturo, Pou-Aguilar Yuri Noemí, Figueroa-Hurtado Esperanza, Vazquez-Lopez Saul, Ortiz Diana L
Respiratory Diseases Clinic, Hospital Regional de Alta Especialidad de la Península de Yucatan, Merida, MEX.
Cureus. 2024 Nov 26;16(11):e74523. doi: 10.7759/cureus.74523. eCollection 2024 Nov.
Patients with severe eosinophilic asthma (SEA) can benefit from biologic therapy but some subjects may present an immune-mediated side effect. These patients will not meet the treatment goals and might have an increased risk of exacerbations. Monitoring these patients by determining blood eosinophil (BE) levels could be one of the tools that may allow a follow-up to prevent a worsening of asthma or exacerbations. The patient was a 50-year-old female with a diagnosis of SEA who had six asthma exacerbations in the last year. Baseline spirometry showed a forced expiratory volume in one second (FEV1) (L) of 0.80 with 34%p (z-score: -4.18) post bronchodilator (BD) and a BE count of 15% (1080 µL cells). After three doses of benralizumab, the spirometry showed an FEV1 (L) of 2.31 with 97%p (z-score: -0.21) post BD and a BE count of 0%. No exacerbations were reported while the patient received biologic medication, but it had to be stopped due to a dermatological allergic reaction. The patient was well-controlled for four months after stopping biologic medication and the BE count also increased, associated with two emergency visits due to exacerbations despite maintenance therapy. Although intolerance or hypersensitivity reactions to the treatment with biologics in asthmatic patients are rare, these patients must discontinue treatment, which increases their risk of exacerbations. In routine medical clinical practice, an easy approach can be made with the follow-up of an accessible and inexpensive test, i.e., the BE count. Its increments should trigger an alert for a closer follow-up and early therapy adjustments.
重度嗜酸性粒细胞性哮喘（SEA）患者可从生物治疗中获益，但部分患者可能出现免疫介导的副作用。这些患者无法达到治疗目标，且病情加重的风险可能增加。通过测定血液嗜酸性粒细胞（BE）水平来监测这些患者，可能是实现随访以预防哮喘恶化或病情加重的手段之一。该患者为一名50岁女性，诊断为SEA，去年有6次哮喘发作。基线肺功能检查显示，支气管扩张剂（BD）治疗后一秒用力呼气容积（FEV1）为0.80L，百分比预计值为34%（z评分：-4.18），BE计数为15%（1080µL细胞）。给予三剂贝那利珠单抗后，肺功能检查显示BD治疗后FEV1为2.31L，百分比预计值为97%（z评分：-0.21），BE计数为0%。患者接受生物治疗期间未报告病情加重情况，但因皮肤过敏反应不得不停药。停用生物治疗后患者病情得到良好控制达4个月，且BE计数也有所增加，尽管接受维持治疗仍因病情加重两次就诊急诊。虽然哮喘患者对生物治疗不耐受或过敏反应罕见，但这些患者必须停药，这增加了他们病情加重的风险。在常规医疗临床实践中，可以通过随访一种便捷且廉价的检查方法，即BE计数，来实现简单的监测。其增加应引发警示，以便进行更密切的随访和早期治疗调整。
