In China,omalizumab is indicated for patients with moderate to severe persistent allergic asthma in whom symptoms remain inadequately controlled despite treatment with inhaled corticosteroids(ICS)in combination with l...In China,omalizumab is indicated for patients with moderate to severe persistent allergic asthma in whom symptoms remain inadequately controlled despite treatment with inhaled corticosteroids(ICS)in combination with long actingβ-agonists(LABA)(GINA step 3 or higher),and urticaria.We report a case of joint and Achilles tendon inflammatory reactions in a patient with Th2-type asthma receiving omalizumab treatment.An adult male presented with recurrent episodes of sneezing,rhinorrhea,wheezing,chest tightness,shortness of breath,and dyspnea.He exhibited allergies to multiple substances and demonstrated impaired lung function,ultimately being diagnosed with allergic rhinitis and asthma.Following initial treatment with ICS and LABA,his symptoms were initially controlled.However,as the disease progressed,the frequency of nocturnal attacks increased,and the incidence of attacks during the allergy season escalated,leading to a significant decline in lung function.Subsequently,he commenced subcutaneous injections of omalizumab at a dosage of 600 mg monthly.There was a partial improvement in the frequency of asthma attacks after two injections.Unfortunately,four days after the first treatment,he reported pain in the right Achilles tendon.Rheumatological screenings,including a five-item antinuclear antibody test and an 11-item autoantibody profile test,revealed no significant abnormalities.Ankle joint ultrasound indicated hyperechoic spots around the Achilles tendon with acoustic shadows,suggesting the presence of Achilles tendinopathy.Ten days later,the pain symptoms resolved spontaneously.Due to the sig-nificant improvement in asthma symptoms,omalizumab treatment continued,albeit with a dosage reduction to 300mg.After intermittent treatment over four sessions,asthma symptoms improved markedly,with the Asthma Control Test(ACT)score increasing from 14 to 20.Lung function improved from moderate obstruction to mild obstruction.The only drawback was the patient’s recurrent swelling,pain,and joint effusion in the joints(specifically the knee and ankle)during the treatment period.Omalizumab is an effective therapeutic option for the treatment of allergic asthma.Although the incidence of adverse events reported in current studies is low,there have been emerging reports of joint swelling,pain,and myalgia reactions in both children and adults receiving treatment for asthma and urticaria.Given the rarity and non-specific nature of these reactions,it is challenging to ascertain the true incidence rate.Previous reports have described symptoms that occur upon initiation of the medication,which can recur upon re-administration.While the factors that may increase the risk of joint inflammatory reactions to omalizumab remain to be elucidated,this case contributes to a deeper understanding of this adverse reaction associated with a well-tolerated and important therapeutic agent.展开更多
文摘In China,omalizumab is indicated for patients with moderate to severe persistent allergic asthma in whom symptoms remain inadequately controlled despite treatment with inhaled corticosteroids(ICS)in combination with long actingβ-agonists(LABA)(GINA step 3 or higher),and urticaria.We report a case of joint and Achilles tendon inflammatory reactions in a patient with Th2-type asthma receiving omalizumab treatment.An adult male presented with recurrent episodes of sneezing,rhinorrhea,wheezing,chest tightness,shortness of breath,and dyspnea.He exhibited allergies to multiple substances and demonstrated impaired lung function,ultimately being diagnosed with allergic rhinitis and asthma.Following initial treatment with ICS and LABA,his symptoms were initially controlled.However,as the disease progressed,the frequency of nocturnal attacks increased,and the incidence of attacks during the allergy season escalated,leading to a significant decline in lung function.Subsequently,he commenced subcutaneous injections of omalizumab at a dosage of 600 mg monthly.There was a partial improvement in the frequency of asthma attacks after two injections.Unfortunately,four days after the first treatment,he reported pain in the right Achilles tendon.Rheumatological screenings,including a five-item antinuclear antibody test and an 11-item autoantibody profile test,revealed no significant abnormalities.Ankle joint ultrasound indicated hyperechoic spots around the Achilles tendon with acoustic shadows,suggesting the presence of Achilles tendinopathy.Ten days later,the pain symptoms resolved spontaneously.Due to the sig-nificant improvement in asthma symptoms,omalizumab treatment continued,albeit with a dosage reduction to 300mg.After intermittent treatment over four sessions,asthma symptoms improved markedly,with the Asthma Control Test(ACT)score increasing from 14 to 20.Lung function improved from moderate obstruction to mild obstruction.The only drawback was the patient’s recurrent swelling,pain,and joint effusion in the joints(specifically the knee and ankle)during the treatment period.Omalizumab is an effective therapeutic option for the treatment of allergic asthma.Although the incidence of adverse events reported in current studies is low,there have been emerging reports of joint swelling,pain,and myalgia reactions in both children and adults receiving treatment for asthma and urticaria.Given the rarity and non-specific nature of these reactions,it is challenging to ascertain the true incidence rate.Previous reports have described symptoms that occur upon initiation of the medication,which can recur upon re-administration.While the factors that may increase the risk of joint inflammatory reactions to omalizumab remain to be elucidated,this case contributes to a deeper understanding of this adverse reaction associated with a well-tolerated and important therapeutic agent.
