V. Le Gros

Omalizumab reduces oral corticosteroid use in patients with severe allergic asthma: real-life data.

BACKGROUND Long-term oral corticosteroid (OCS) therapy is associated with significant burden on patients and healthcare resources; treatments that may help reduce their use are important to improve asthma management. METHODS French and German clinicians prescribing omalizumab for >16 weeks to patients with severe persistent allergic asthma collected OCS use data. OCS use was recorded at baseline and at a non-specific time point beyond 16 weeks from initiation of omalizumab. The number of asthma exacerbations (FEV(1) < 60% of personal best, requiring OCS burst and unscheduled doctor/emergency visit or hospitalization) and asthma-related hospitalizations during the 12-months prior to omalizumab treatment and during the observation period were also recorded. RESULTS Overall, 346 patients were treated with omalizumab for >16 weeks. Of these, 166 (48.0%) were receiving maintenance OCS (France, n = 64; Germany, n = 102). Following omalizumab therapy, 84 (50.6%) patients on OCS at baseline reduced/stopped OCS dose at the time of data collection; 34 (20.5%) stopped and 50 (30.1%) reduced OCS. In all patients receiving maintenance OCS at baseline, mean reduction from baseline in daily OCS dose was 29.6% (7.1 mg prednisolone). In patients who reduced/stopped maintenance OCS, mean reduction from baseline in daily OCS dose was 74.3% (15.4 mg prednisolone). Reductions in exacerbations and hospitalizations were observed from the 12-months prior to baseline in patients at the time of data collection, irrespective of change in OCS dose. CONCLUSION European real-life experience demonstrates the OCS-sparing potential of omalizumab in some patients with severe allergic (IgE-mediated) asthma.

Omalizumab decreases nonspecific airway hyperresponsiveness in vitro

Background:  In asthmatic patients, both symptoms and hyperresponsiveness are related to immunoglobulin E (IgE) concentration in serum. The anti‐IgE monoclonal antibody omalizumab improved the control of asthma, but its effect on airway hyperresponsiveness is controversial. Passive sensitization reproduced in vitro a bronchial hyperresponsiveness, an increase in IgE bearing cells, and a mast cell degranulation. This study was designed to examine the effect of omalizumab on passive sensitization‐induced hyperresponsiveness, alterations in IgE positive inflammatory cells and mast cell degranulation within the bronchial wall.

FEV1 reversibility does not adequately predict effect of formoterol via Aerolizer® in chronic obstructive pulmonary disease

Evaluation of patients with chronic obstructive pulmonary disease (COPD) often includes the use of post‐bronchodilator reversibility testing to guide treatment decisions. Recommendations for reversibility testing differ and there is no universally accepted method or outcome criterion.

ALLERGY Net: Effectiveness of omalizumab in monozygotic twin sisters with severe allergic asthma: ALLERGY Net

3 mm above the negative control) to kiwi, pear, banana, watermelon, cherry, passion fruit, walnut, pistachio and latex (wheal diameters of 4, 5, 5, 6, 5, 5, 4, 3 and 12 mm, respectively; positive control 8 mm and negative control 0 mm). The skin prick–prick tests to several raw foods and latex revealed positive to latex, chestnut, walnut, pistachio nut, blackberry, tomato, zucchini and turnip (wheal diameter of 12, 13, 5, 4, 4, 5, 7 and 5 mm; positive control 6 mm and negative control 0 mm). The total serum IgE level was 34 IU/l and the serum-specific IgE to latex 3.2 KU/l (ImmunoCAP, Phadia, Uppsala, Sweden). As the sensitization to turnip and zucchini were not previously described in the latex–vegetable–fruit syndrome, we decided to proceed with further investigation. The specific serum IgE to turnip and zucchini revealed 0.64 and <0.35KU/l, respectively. Previous incubation of serum with turnip and latex nondiluted extracts resulted in an inhibition of 99.3% and 93%, respectively, of turnip ImmunoCAPs reaction. Latex ImmunoCAP reaction was inhibited with both zucchini and turnip extract, respectively (Fig. 1A). Specific IgE levels to rHev b1 (Rk215), rHev b5 (Rk218) and rHev b6.01 (Rk219) were 0, 0.31 and 2.9 KU/l, respectively. Inhibition study of rHev b6.01 with nondiluted extracts of turnip and zucchini revealed an inhibition of 63% and 52.3%, respectively (Fig. 1B). Despite cross-reactivity between zucchini and latex had been previously described (3) with this study, we could prove for the first time cross-reactivity between turnip and latex and identify Hev b6.01, the chitin-binding protein, as the protein responsible in this latex–fruit syndrome. Turnip and zucchini should be added to the long list of plant-derived foods crossreactive to latex and sensitization to these vegetables must be assessed in patients with latex anaphylaxis.

ALLERGY Net: Effectiveness of omalizumab in monozygotic twin sisters with severe allergic asthma

3 mm above the negative control) to kiwi, pear, banana, watermelon, cherry, passion fruit, walnut, pistachio and latex (wheal diameters of 4, 5, 5, 6, 5, 5, 4, 3 and 12 mm, respectively; positive control 8 mm and negative control 0 mm). The skin prick–prick tests to several raw foods and latex revealed positive to latex, chestnut, walnut, pistachio nut, blackberry, tomato, zucchini and turnip (wheal diameter of 12, 13, 5, 4, 4, 5, 7 and 5 mm; positive control 6 mm and negative control 0 mm). The total serum IgE level was 34 IU/l and the serum-specific IgE to latex 3.2 KU/l (ImmunoCAP, Phadia, Uppsala, Sweden). As the sensitization to turnip and zucchini were not previously described in the latex–vegetable–fruit syndrome, we decided to proceed with further investigation. The specific serum IgE to turnip and zucchini revealed 0.64 and <0.35KU/l, respectively. Previous incubation of serum with turnip and latex nondiluted extracts resulted in an inhibition of 99.3% and 93%, respectively, of turnip ImmunoCAPs reaction. Latex ImmunoCAP reaction was inhibited with both zucchini and turnip extract, respectively (Fig. 1A). Specific IgE levels to rHev b1 (Rk215), rHev b5 (Rk218) and rHev b6.01 (Rk219) were 0, 0.31 and 2.9 KU/l, respectively. Inhibition study of rHev b6.01 with nondiluted extracts of turnip and zucchini revealed an inhibition of 63% and 52.3%, respectively (Fig. 1B). Despite cross-reactivity between zucchini and latex had been previously described (3) with this study, we could prove for the first time cross-reactivity between turnip and latex and identify Hev b6.01, the chitin-binding protein, as the protein responsible in this latex–fruit syndrome. Turnip and zucchini should be added to the long list of plant-derived foods crossreactive to latex and sensitization to these vegetables must be assessed in patients with latex anaphylaxis.