It is well known that some patients with severe persistent asthma remain inadequately controller despite receiving best available treatment and optimal management efforts. Such patients, who have exhausted the therapeutic options available to them , are at risk of experiencing serious exacerbations and asthma related mortality
We present two cases treated with omalizumab
35 years old female brasilian, ,work as housekeeper, with rhinitis and asthma since age 12. She experienced several hospital admissions, frequent use of nebulizer, asthma worsening with numerous courses of iv and oral corticosteroids. Skin prick tests were positive to dermatophagoides, grass, birch, plantago. Fev1= 25% ( of predicted) reversing to 42%, total serum IgE = 91 IU/ml .
She started Xolair in 2007 and after few months she improved her symptoms, reduced drugs and stopped with oral corticosteroids. In 2009 she had no hospitalizations, can work normally. IgE = 281 IU/mL, FEV1= 57% reversed to 71%. Her health has improved and they are not so worried any more when she is out and about work and free time.
Severe persistent allergic asthma, 67 years old , severe asthma symptoms and exacerbations since 1980, ex smoker, ex bricklayer, obesity, hypertension, diabetes mellitus. He had rhinitis and asthma due to allergy to mite and was treated with subcutaneous specific immunotheraphy for 10 years with symptoms’ disappeared. Since 2005 started with frequent asthma exacerbations ( 5 times per year ) required emergency treatment or hospitalization. Exacerbations and symptoms limited his activities of daily living, nocturnal symptoms, poor control despite maintenance oral steroids, inhaled steroids, salmeterol, cromoglycate, theophylline trials and need long term oxygen theraphy.
In July 2007 skin prick test were positive for dermathophagoides, IgE= 435 U/ml, FEV1 =70%. He started with Xolair treatment and after two months stopped oral corticosteroids and after fourth months stopped oxygen therapy. In January 2010 FEV 1 =75%, Total serum IgE : 494 IU/mL. Improved symptoms, reduced wheezing shortness of breath, nocturnal symptoms uncommon. Sleeps through the night. Fewer exacerbations. No hospitalizations since starting xolair
Xolair doses were determined by serum total IgE levels measured before treatment initiation and patient’s body weight. Dosing tables were used to calculate the appropriate dose.
No side effects were reported.