No abstract

BackgroundCurrent therapy for allergic bronchopulmonary aspergillosis (ABPA) uses oral corticosteroids, exposing patients to the adverse effects of these agents. There are reports of the steroid-sparing effect of anti-IgE therapy with omalizumab for ABPA in patients with cystic fibrosis (CF), but there is little information on its efficacy against ABPA in patients with bronchial asthma without CF.ObjectiveTo examine the effects of omalizumab, measured by asthma control, blood eosinophilia, total serum immunoglobulin E (IgE), oral corticosteroid requirements, and forced expiratory volume spirometry in patients with ABPA and bronchial asthma.MethodsA retrospective review of charts from 2004–2006 of patients treated with omalizumab at an academic allergy and immunology practice in the Bronx, New York were examined for systemic steroid and rescue inhaler usage, serum immunoglobulin E levels, blood eosinophil counts, and asthma symptoms, as measured by the Asthma Control Test (ACT).ResultsA total of 21 charts were screened for the diagnosis of ABPA and bronchial asthma. Four patients with ABPA were identified; two of these patients were male. The median monthly systemic corticosteroid use at 6 months and 12 months decreased from baseline usage. Total serum IgE decreased in all patients at 12 months of therapy. Pre-bronchodilator forced expiratory vital capacity at one second (FEV1) was variable at 1 year of treatment. There was an improvement in Asthma Control Test (ACT) symptom scores for both daytime and nighttime symptoms.ConclusionsTreatment with omalizumab creates a steroid-sparing effect, reduces systemic inflammatory markers, and results in improvement in ACT scores in patients with ABPA.

RATIONALE: Dengue is a self-limited, viral infection transmitted by mosquitoes with clinical presentations, from undifferentiated fever to severe dengue that may cause death. Epidemiologic studies had associated asthma with severe dengue, our study aims to describe demographic characteristics and clinical manifestations of laboratory confirmed dengue cases with past medical history of asthma. METHODS: Data was collected from patients enrolled in the Sentinel Enhanced Dengue Surveillance System (SEDSS) established in St. Luke's Episcopal Hospitals in Ponce and Guayama, Puerto Rico from May 7, 2012 to May 6, 2015. We compared asthmatic cases with intermittent and persistent disease to determine their risk for severe dengue. SEDSS collects clinical and demographic data and specimens for testing with RT-PCR appropriate for dengue virus. RESULTS: Of 1,691 enrolled patients with history of asthma, 169 had confirmed dengue. 50.9% were male; median age 14.0 years (range: 1-73). 77.5% were under 19 years. 46.7% were admitted to the hospital, 55.7% were between 10-19 years. One case was transferred to another institution (0.6%) no deaths were reported. Common symptoms upon presentation were headache (148, 88.1%), fever (126, 76.4%), muscle pain (114, 68.7%), facial flush (100, 59%) and rash (81, 50.3%). CONCLUSIONS: Patients with a history of asthma and laboratory confirmed dengue had similar symptoms as dengue cases described in the medical literature. Admission rates were high for this group, further analysis is being conducted to characterize and compare asthma severity among patients enrolled in SEDSS who developed severe dengue during their clinical course.