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Practitioner's Corner

J Investig Allergol Clin Immunol 2019; Vol. 29(5): 378-398

© 2019 Esmon Publicidad

the BVAS was 0, and FEV

1

was 92% of predicted. There were

no exacerbations, and we were able to reduce prednisone to

2.5 mg/d.

The other patient was a 27-year-old nonsmoking man with

a long history of recurrent nasal polyposis and eosinophilic

asthma treated with high-dose inhaled corticosteroids and long-

acting ß

2

-agonists, antileukotrienes, and oral corticosteroids.

His symptoms were uncontrolled, and he had considerable peak

flow variability (>15%). He presented with erythematous skin

lesions (Figure) compatible with biopsy-proven eosinophilic

extravascular granuloma and bilateral, patchy, ground glass

opacities, with an upper lung distribution on the chest CT scan

(SupplementaryMaterial). The blood tests revealed eosinophilia

(40%), increased CRP and IgE levels (2.28 mg/dL and 2970 IU/

mL, respectively), and negative ANCA titers. FEV

1

was

115% of predicted. The patient was initially treated with

prednisone 60 mg/d (0.75 mg/kg/d), with 10 mg/d the lowest

dose reached because of recurrent symptoms when it was

reduced. Subcutaneous mepolizumab was started at 300 mg

every 4 weeks. Before starting mepolizumab, the laboratory

values were as follows: blood eosinophil count, 35%; serum

IgE, 996 IU/mL; and CRP, 0.26 mg/dL. The BVAS was ˃3,

and FEV

1

was 108% of predicted. Six months later, the patient

was asymptomatic without exacerbations. In addition, blood

eosinophilia and IgE levels decreased (1.2% and 209 IU/mL,

respectively), BVAS was 0, and FEV

1

was 89% of predicted.

Therefore, the dose of corticosteroid was reduced.

No allergic reactions or adverse events or relapses were

associated with mepolizumab in either case.

In summary, our results are consistent with those of

previous studies [6-8]. Mepolizumab may be considered a

therapeutic option in patients with refractory corticosteroid

EGPA in order to reduce the dose of corticosteroids and their

adverse effects and thus improve quality of life.

Funding

The authors declare that no funding was received for the

present study.

Conflicts of Interest

Dr. Garcia Moguel has participated in advisory boards

and acted as a speaker/investigator for Novartis, AstraZeneca,

Teva, GSK, Chiesi, Allergy therapeutics, Leti, Stallergenes,

ALK-Abelló, Mundipharma, Pfizer, and Orion Pharma.

The remaining authors declare that they have no conflicts

of interest.

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Manuscript received March 4, 2019; accepted for publication

April 25, 2019.

Vania Cecilia Prudencio Ribera

E-mail:

prudenciovania@yahoo.com

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