Suchergebnisse

Aleksandra Kucharczyk,1 Ewa WiÄ™sik-Szewczyk,1 Anna PoznaÅ"ska,2 Karina Jahnz-Różyk1 1Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland; 2Department of Population Health Monitoring and Analysis, National Institute of Public Health – National Institute of Hygiene, Warsaw, PolandCorrespondence: Ewa WiÄ™sik-SzewczykDepartment of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Szaserów 128, Warsaw 01-141, PolandTel/ Fax +48 261 816 581Email ewa.w.szewczyk@gmail.comIntroduction: Omalizumab is a high-cost therapy recommended for the treatment of severe allergic asthma.Objective: To find clinical parameters that are related to the sustained response to omalizumab.Patients and Methods: This retrospective, real-life, 4-year follow-up was provided in Poland between March 2013 and May 2019. The success of omalizumab was assessed based on composed subjective and objective criteria. Simple/multiple regression analyses were performed to search for predictors of the response to omalizumab.Results: A total of 989 severe allergic asthma patients were referred for omalizumab therapy, of whom 854 patients were considered eligible for treatment. At weeks 16 and 52, omalizumab was successful in 84% and 91% of patients, respectively. Treatment effectiveness was maintained up to the 4-year follow-up. Four predictors of the response to omalizumab were found at week 16 and two at week 52. The results at week 16 may be used as predictors of success at week 52 based on the model including baseline FEV1% and change in ACQ-7 and miniAQLQ score at week 16: the area under the ROC curve equals 0.746 [95% CI: 0.672– 0.820].Conclusion: Omalizumab therapy is very effective, with this efficacy sustained after 4 years of treatment. Success of the therapy can be predicted from the baseline FEV1% and clinical improvement (based on ACQ-7 and miniAQLQ scores) at week 16.Keywords: allergic asthma, anti-IgE, biologics, personalized therapy

Ewa WiÄ™sik-Szewczyk,1 Anna Felis-Giemza,2 MirosÅ'aw Dziuk,3 Karina Jahnz-Różyk1 1Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defense, Military Institute of Medicine in Warsaw, Warsaw, Poland; 2Department of Connective Tissue Diseases, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; 3Department of Nuclear Medicine, Military Institute of Medicine in Warsaw, Warsaw, PolandCorrespondence: Ewa WiÄ™sik-SzewczykDepartment of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Military Institute of Medicine in Warsaw, Szaserów 128 01-141, Warsaw, PolandTel/Fax +48 261 816 581Email ewa.w.szewczyk@gmail.comAbstract: A 32-year-old-man, with a history of chronic urticaria from the age of 27, diagnosed with an adult-onset Still's disease and received a low dose of glucocorticoids, methotrexate and tocilizumab. Despite the long-term combined treatments, he suffered from chronic urticaria, low-grade fever and bone pain. He was found to have high inflammatory markers, hypogammaglobulinemia, monoclonal IgM – kappa light chain in serum and increased radiotracer uptake in the whole bone scintigraphy. No pathological variants for monogenic autoinflammatory diseases were present in the genome exome sequencing. These investigations confirmed the diagnosis of Schnitzler syndrome, which is an exception before the age of 35. Switching from tocilizumab to interleukin 1 receptor inhibitor, anakinra led to a full clinical response and normalisation of inflammatory markers. Patients with a history of fever and chronic urticaria are routinely tested for monoclonal gammopathy in the context of malignancy, but it should also be considered as a sign of the autoinflammatory syndrome. The Schnitzler syndrome and the adult-onset Still's disease share common features, so the diagnosis requires a thorough investigation to establish an optimal treatment. In the diagnostic algorithm, monoclonal gammopathy is usually considered red flag for malignancy but might be overlooked as a criterion of Schnitzler syndrome, particularly in young adults. We confirm that the interleukin 1 inhibitor should be the first line of therapy in Schnitzler syndrome, and in the presented case we found it more effective than the interleukin 6 blockade. The main goal of this paper is to increase awareness of Schnitzler syndrome among health care professionals. We aim to present features which can be helpful in differential diagnosis.Keywords: chronic urticaria, monoclonal gammopathy, tocilizumab, anakinra, autoinflammation