scholarly journals Differential response to biologics in a patient with severe asthma and ABPA: a role for dupilumab?

2020 ◽  
Vol 16 (1) ◽  
Author(s):  
Carlo Mümmler ◽  
Bernd Kemmerich ◽  
Jürgen Behr ◽  
Nikolaus Kneidinger ◽  
Katrin Milger
Keyword(s):  
Lung Function ◽  
Severe Asthma ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Oral Steroid ◽  
Case Presentation ◽  
Oral Steroids ◽  
Treatment Responses ◽  
Oral Steroid Therapy ◽  
Switching Treatment ◽  
Severe Hypersensitivity Reaction

Abstract Background Allergic bronchopulmonary aspergillosis (ABPA) is a severe hypersensitivity reaction to aspergillus species colonizing the airways of patients with asthma or cystic fibrosis. Biologics including anti-IgE and anti-IL5 antibodies have strongly changed the treatment of severe asthmatics and have partly been reported to be effective in the treatment of ABPA. Recently, dupilumab, an anti-IL4-Rα antibody which inhibits signaling by the Th2-cytokines IL4 and IL13, has been approved for the treatment of severe asthma. Case presentation Here, we report the case of a 49-year-old woman with severe asthma and ABPA, who was uncontrolled despite maximum inhalative therapy, anti-IL5-Rα antibody and continuous oral steroid therapy. Moreover, trials of itraconazole as well as omalizumab showed insufficient efficacy. Lung function revealed peripheral obstruction. FeNO and IgE were increased, eosinophils were suppressed under treatment while marked increases had been documented previously. Switching to dupilumab led to a complete resolution of pulmonary symptoms, resolution of exacerbations and complete withdrawal of oral steroids. A drastic improvement in lung function was noted, with an increase in FEV1 of almost 1 l. FeNO was normalized and IgE strongly reduced. Conclusion Our case highlights that a patient may exhibit differential treatment responses to the currently available asthma biologics and suggests switching treatment if outcome is insufficient. A potential role for dupilumab in the treatment of ABPA warrants future studies.

scholarly journals The effects of oral steroid therapy on prolidase enzyme activity in patients with nasal polyps

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Adnan Ekinci ◽  
Huseyin Kayadibi ◽  
Emre Demir ◽  
Muge Ozcan
Keyword(s):  
Enzyme Activity ◽  
Steroid Therapy ◽  
Nasal Polyps ◽  
Oral Steroid ◽  
Serum Samples ◽  
Before And After ◽  
Oral Steroids ◽  
Inflammatory Processes ◽  
Oral Steroid Therapy

Abstract Objective To compare prolidase enzyme activity (PEA) in serum and polyp specimens of patients with nasal polyps obtained before and after the oral steroid therapy. Materials and methods Thirty three patients with nasal polyps (39 ± 13 years) received 1 mg/kg of oral steroids. Serum samples were collected from each patient, but nasal polyp specimens could be obtained only from 23 patients (38 ± 13 years) before and after the oral steroid therapy. PEA was measured by ELISA method. Results Serum PEA values were 210 (176–242) U/L and 184 (147–217) U/L before and after the oral steroid therapy, respectively (p = 0.015). Polyp tissue PEA was 1337 (738–2130) U/g and 871 (590–1663) U/g before and after the oral steroid therapy, respectively (p = 0.429). Conclusion In patients with nasal polyps, significantly lower serum PEA after the oral steroid therapy may be a consequence of the role of prolidase enzyme in inflammatory processes which are important for the development of nasal polyps. More comprehensive studies with larger sample sizes are needed to elucidate the role of PEA in the pathogenesis of nasal polyps.

Oral Steroid Therapy for Chronic Middle Ear Perfusion: A Double-Blind Crossover Study

1986 ◽  
Vol 95 (2) ◽  
pp. 193-199 ◽  
Author(s):  
Paul R. Lambert
Keyword(s):  
Crossover Study ◽  
Middle Ear ◽  
Oral Steroid ◽  
Double Blind ◽  
Treatment Regimens ◽  
Oral Steroids ◽  
Ventilation Tubes ◽  
Oral Steroid Therapy ◽  
Blind Crossover Study ◽  
Double Blind Crossover Study

A prospective, double-blind crossover study design was used in the evaluation of the role of prednisone in the treatment of a chronic middle ear effusion. Sixty children with an effusion—of at least 2 months’ duration—randomly received either prednisone or placebo for 2 weeks. One week later they were re-evaluated. If the effusion had resolved, they were followed periodically; if the effusion persisted, they were given the crossover regimen and reevaluated. Sixty percent of the patients’ effusions cleared, but there was no statistical difference between the prednisone and placebo groups. The amount of hearing recovery was also the same for both treatment regimens. Subdividing the patients on the basis of effusion duration, unilateral vs. bilateral effusions, or history of ventilation tubes or antibiotics failed to identify a subgroup of individuals who might benefit from a short-term course of oral steroids.

scholarly journals Effect of Intratympanic Dexamethasone in Idiopathic Sudden Sensorineural Hearing Loss

2019 ◽  
Vol 27 (2) ◽  
pp. 135-139
Author(s):  
Rabi Hembrom ◽  
Indranil Sen ◽  
Bina Tamang ◽  
Satadal Mandal ◽  
Amit Chakrabarti
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Oral Steroid ◽  
Hearing Improvement ◽  
Oral Steroids ◽  
Oral Steroid Therapy ◽  
A Prospective Study ◽  
Intratympanic Dexamethasone

Introduction Oral steroids currently represent the standard treatment for idiopathic sudden sensorineural hearing loss The aim of this study is to assess the effectiveness of intratympanic dexamethasone injection for treating ‘Idiopathic sudden sensori-neural hearing loss’ (ISSNHL) not improved with conventional oral steroid. Materials and Methods A prospective study was conducted on 30 patients refractory to oral steroid therapy between June 2017 to May 2018. ‘Intratympanic dexamethasone injection’ (ITDI) was given every week for 3 consecutive weeks. Hearing was assessed by performing pure tone audiogram before every ITDI and also 1 week after the completion of treatment. Results Hearing improvement was found in 19 out of the 30 cases (63.3%).   Conclusions Intratympanic dexamethasone significantly improves the prognosis of ISSNHL and is a safe, inexpensive and effective treatment.

Dupilumab Effect on Lung Function in Patients with Uncontrolled, Moderate-to-Severe Asthma with an Allergic Phenotype

2020 ◽  
Author(s):  
M Castro ◽  
J Corren ◽  
TB Casale ◽  
S Quirce ◽  
MS Rice ◽  
...  
Keyword(s):  
Lung Function ◽  
Severe Asthma

Focal vasculitic myositis as a primary manifestation of Behçet’s disease: a case series of 10 Korean patients in a locomotive medicine clinic

Rheumatology ◽  
2021 ◽  
Author(s):  
Du Hwan Kim ◽  
Sun Woong Kim ◽  
Seung Mi Yeo ◽  
Min-Soo Kang ◽  
Young Cheol Yoon ◽  
...  
Keyword(s):  
Steroid Therapy ◽  
Behcet’S Disease ◽  
Behçet's Disease ◽  
Adult Patients ◽  
Oral Steroid ◽  
Imaging Findings ◽  
Behcet's Disease ◽  
Medicine Clinic ◽  
Oral Steroid Therapy

Abstract Objectives Muscle involvement in Behçet’s disease (BD) is rare, and several cases have been reported in the literature. Therefore, this study aimed to describe the clinical, laboratory and imaging findings in adult patients presenting with BD-associated myositis before the diagnosis of BD. Methods We retrospectively screened patients who visited a locomotive medicine clinic presenting with myalgia, local swelling, or tenderness of extremities without an established diagnosis of BD. We enrolled patients whose pain in the extremities was proven to be suggestive of focal vasculitic myositis and who were eventually diagnosed as having BD at the initial visit or during follow-up. We thoroughly reviewed the clinical, histological and imaging findings and treatment outcomes in patients who presented with focal vasculitic myositis as the primary manifestation of BD. Results Ten adult patients with focal vasculitic myositis as the primary manifestation of BD were enrolled. The lower and upper extremities were affected in eight and two patients, respectively. The affected lower extremities were the calf (n = 6) and thigh muscles (n = 2). The common findings of MRI included high signal intensity of the affected muscles and intermuscular fascia on fat-suppressed images, suggestive of myofascitis and oedematous changes in the subcutaneous layer. The results of skin or muscle biopsy were suggestive of vasculitis. All the patients were pain-free at the short-term follow-up (1–3 weeks) after oral steroid therapy. Conclusion Focal vasculitic myositis can be a primary manifestation of BD warranting medical attention. BD-associated myositis responds well to oral steroid therapy.

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