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P168 Cystic fibrosis immunotherapy: use of combination chemotherapy for treatment of cystic fibrosis lung disease
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Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124
inhaled steroids, so Omalizumab was initiated. Prednisone was gradually tapered and currently he does not require systemic steroids. On Omalizumab, his EGPA has not recurred, AFRS has significantly improved, and asthma is well controlled. Conclusion: We present an uncommon case of young man with rare combination of asthma, EGPA, and AFRS who was also found to have seropositive Allergic Bronchopulmonary Aspergillosis, all responsive to Omalizumab.
P168 CYSTIC FIBROSIS IMMUNOTHERAPY: USE OF COMBINATION CHEMOTHERAPY FOR TREATMENT OF CYSTIC FIBROSIS LUNG DISEASE I. Randhawa*, C. Caperton, E. Nussbaum, Long Beach, CA.
myositis) (n¼32) and structural (OA) (n¼28). Data were analyzed with T test, Mann-Whitney 2 etailed test and logistic regression. Results: Rheum patients with structural/OA were significantly older (64 yrs vs.53.6 yrs, p<0.01) than immune rheum. There was no difference between immune rheum patients and structural rheum for asthma (n¼8, 7, respectively) or allergic rhinitis (n¼11, 10, respectively) (p¼ns). Presence of asthma, but not allergic rhinitis, was associated with greater BMI (35.0 vs 30.0, 31.8 vs. 31.0. p¼0.035, 0.52, respectively). Finally, there was no association of immune rheum with presence of asthma or allergic rhinitis (p¼ns for both). Conclusions: Obesity, but not presence of rheum immune disorders, associate with presence of asthma, but not allergic rhinitis for our mixed cohort.
P170
Introduction: Immunologic disease in cystic fibrosis (CF) comprises chronic elevation of pro-inflammatory cytokines tumor necrosis factor-a, IL-6, and IL-8, which mediate neutrophil trafficking and chemotaxis. Neutrophils have been implicated in CF lung disease in patients as young as 4 weeks. The terminal aspect of CF lung disease is characterized by bronchiectasis, cystic lesions, and parenchymal fibrosis. The goal of this pilot study is to retrospectively analyze the impact of immunomodulatory agents on CF lung function and comorbidities while assessing risk for potential complications of immunosuppression. Methods: A retrospective chart review of patients with CF who were treated with combination chemotherapy with azathioprine and cyclosporine was performed. Complete pulmonary function tests (PFTs), intravenous and oral antibiotic use, and hospitalizations were documented from one year prior to therapy through one year during therapy. The outcome differences between pre- and post-treatment parameters were analyzed. Results: Eleven patients with CF met inclusion criteria. Significant post-treatment increases in both FEV1 (p¼0.024) and FVC (p¼0.033) were observed. Treatment recipients had fewer hospitalizations (p¼0.041) and significantly reduced intravenous antibiotic use (p-0.023), with a trend toward significantly reduced oral antibiotic use as well (p¼0.051). No patient developed immunosuppressionassociated microbes such as Burkholderia or Mycobacterium or other significant chemotherapy-related complications. Conclusions: In this cohort of patients with cystic fibrosis lung disease, combination chemotherapy significantly improved pulmonary function, reduced hospitalizations, and decreased requirements for intravenous antibiotic therapy while simultaneously having no significant immunosuppression-related infections or chemotherapy-related complications. Combination chemotherapy with azathioprine and cyclosporine should be considered in the treatment armamentarium for these patients.
SUCCESSFUL TREATMENT WITH OMALIZUMAB OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (ABPA) IN A CYSTIC FIBROSIS (CF) SUBJECT C. Lin*1, F. Tabatabaian2, R. Lockey3, 1. Temple Terrace, FL; 2. Lutz, FL; 3. Tampa, FL.
P169
P171
ALLERGY AND ASTHMA AMONG ADULTS WITH RHEUMATIC DISORDERS IN AN INNER CITY UNIVERSITY FACULTY PRACTICE Y. Yan*1, T. Al-Shaikhly1, M. Vastardi1, R. Joks2, 1. Brooklyn, NY; 2. Port Washington, NY.
IMPROVEMENT OF REFRACTORY EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS WITH MEPOLIZUMAB INITIATED FOR SEVERE ATOPIC ASTHMA M. Love*, S. Gierer, M. Maz, Kansas City, KS.
Background: Whether non-allergic chronic inflammatory conditions associate with presence of asthma and allergic disease is not fully known. Both rheumatoid arthritis (RA) and obesity are associated with asthma and allergic rhinitis. How other rheumatic conditions (OA, SLE) associate with asthma and allergy has not been determined. Methods: A retrospective chart review (2012-16) of adult patients with rheumatologic disorders (including RA, SLE, osteoarthritis) (n¼60) treated in a University based Allergy/Arthritis practice determined concurrent diagnosis of asthma and allergic rhinitis. Rheum. Disorders were categorized into immune (RA, SLE,
Introduction: ABPA is an exaggerated hypersensitivity response usually to Aspergillus fumigatus. CF subjects often have Aspergillus fumigatus colonization and ABPA because of impaired airway clearance. Systemic glucocorticosteroid is a treatment of choice for ABPA but when used chronically, results in significant side effects. Successful treatment with omalizumab, a monoclonal antibody against IgE, is reported in an ABPA-CF subject. Methods: A 15-year-old female with CF, pancreatic insufficiency, and asthma is found to have a serum eosinophilia, 770 cells/ mL (reference range 0 to 610) and elevated IgE,1123 IU/mL (reference range 0 to 100) during a hospital admission for pneumonia. A bronchoalveolar lavage culture grew both Pseudomonas aeruginosa and Aspergillus fumigatus. She remained symptomatic despite regular asthma treatment, tobramycin 300 mg/5 ml nebulized by inhalation twice/day, and oral pancreatic enzymes. Otherwise her past medical, social and family histories and review of systems were unremarkable. Results: A diagnosis of ABPA was made based on a positive Aspergillus fumigatus skin prick test (4+, wheal 10 mm and erythema 40 mm in diameter); specific IgE to Aspergillus fumigatus, 40.1 kU/L, (<0.34); IgG to Aspergillus fumigatus, 107 mg/L, (< 46); elevated IgE, 1123 IU/mL; bronchiectasis on CT; and asthma. Omalizumab 300 mg subcutaneous, every 2 weeks, was initiated. The subject had substantial improvement in respiratory symptoms and pulmonary function test results with a forced expiratory volume in first second (FEV1) increase of 300 ml from baseline at a three month follow-up visit. Conclusion: Omalizumab may be an alternative treatment for ABPA in CF subjects.
Case Presentation: We present a 32-year-old female with severe refractory atopic asthma, eosinophilic granulomatosis with polyangiitis (EGPA), allergic rhinoconjunctivitis with nasal polyposis who failed first and several second-line therapies for EGPA and atopy. Despite nasal polypectomies, aggressive nasal and pulmonary medication management including omalizumab, inhaled and intranasal corticosteroids, cyclophosphamide, mycophenolate mofetil, azathioprine, and rituximab; the patient continued to require chronic high dose steroid therapy. Allergen skin prick testing was positive to dust mites, cat, dog, and molds. Hoping to reduce steroid use and improve asthma management, monthly mepolizumab 100 mg subcutaneously was initiated with rapid
Abstracts: Poster Sessions / Ann Allergy Asthma Immunol 117 (2016) S22eS124
inhaled steroids, so Omalizumab was initiated. Prednisone was gradually tapered and currently he does not require systemic steroids. On Omalizumab, his EGPA has not recurred, AFRS has significantly improved, and asthma is well controlled. Conclusion: We present an uncommon case of young man with rare combination of asthma, EGPA, and AFRS who was also found to have seropositive Allergic Bronchopulmonary Aspergillosis, all responsive to Omalizumab.
P168 CYSTIC FIBROSIS IMMUNOTHERAPY: USE OF COMBINATION CHEMOTHERAPY FOR TREATMENT OF CYSTIC FIBROSIS LUNG DISEASE I. Randhawa*, C. Caperton, E. Nussbaum, Long Beach, CA.
myositis) (n¼32) and structural (OA) (n¼28). Data were analyzed with T test, Mann-Whitney 2 etailed test and logistic regression. Results: Rheum patients with structural/OA were significantly older (64 yrs vs.53.6 yrs, p<0.01) than immune rheum. There was no difference between immune rheum patients and structural rheum for asthma (n¼8, 7, respectively) or allergic rhinitis (n¼11, 10, respectively) (p¼ns). Presence of asthma, but not allergic rhinitis, was associated with greater BMI (35.0 vs 30.0, 31.8 vs. 31.0. p¼0.035, 0.52, respectively). Finally, there was no association of immune rheum with presence of asthma or allergic rhinitis (p¼ns for both). Conclusions: Obesity, but not presence of rheum immune disorders, associate with presence of asthma, but not allergic rhinitis for our mixed cohort.
P170
Introduction: Immunologic disease in cystic fibrosis (CF) comprises chronic elevation of pro-inflammatory cytokines tumor necrosis factor-a, IL-6, and IL-8, which mediate neutrophil trafficking and chemotaxis. Neutrophils have been implicated in CF lung disease in patients as young as 4 weeks. The terminal aspect of CF lung disease is characterized by bronchiectasis, cystic lesions, and parenchymal fibrosis. The goal of this pilot study is to retrospectively analyze the impact of immunomodulatory agents on CF lung function and comorbidities while assessing risk for potential complications of immunosuppression. Methods: A retrospective chart review of patients with CF who were treated with combination chemotherapy with azathioprine and cyclosporine was performed. Complete pulmonary function tests (PFTs), intravenous and oral antibiotic use, and hospitalizations were documented from one year prior to therapy through one year during therapy. The outcome differences between pre- and post-treatment parameters were analyzed. Results: Eleven patients with CF met inclusion criteria. Significant post-treatment increases in both FEV1 (p¼0.024) and FVC (p¼0.033) were observed. Treatment recipients had fewer hospitalizations (p¼0.041) and significantly reduced intravenous antibiotic use (p-0.023), with a trend toward significantly reduced oral antibiotic use as well (p¼0.051). No patient developed immunosuppressionassociated microbes such as Burkholderia or Mycobacterium or other significant chemotherapy-related complications. Conclusions: In this cohort of patients with cystic fibrosis lung disease, combination chemotherapy significantly improved pulmonary function, reduced hospitalizations, and decreased requirements for intravenous antibiotic therapy while simultaneously having no significant immunosuppression-related infections or chemotherapy-related complications. Combination chemotherapy with azathioprine and cyclosporine should be considered in the treatment armamentarium for these patients.
SUCCESSFUL TREATMENT WITH OMALIZUMAB OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (ABPA) IN A CYSTIC FIBROSIS (CF) SUBJECT C. Lin*1, F. Tabatabaian2, R. Lockey3, 1. Temple Terrace, FL; 2. Lutz, FL; 3. Tampa, FL.
P169
P171
ALLERGY AND ASTHMA AMONG ADULTS WITH RHEUMATIC DISORDERS IN AN INNER CITY UNIVERSITY FACULTY PRACTICE Y. Yan*1, T. Al-Shaikhly1, M. Vastardi1, R. Joks2, 1. Brooklyn, NY; 2. Port Washington, NY.
IMPROVEMENT OF REFRACTORY EOSINOPHILIC GRANULOMATOSIS WITH POLYANGIITIS WITH MEPOLIZUMAB INITIATED FOR SEVERE ATOPIC ASTHMA M. Love*, S. Gierer, M. Maz, Kansas City, KS.
Background: Whether non-allergic chronic inflammatory conditions associate with presence of asthma and allergic disease is not fully known. Both rheumatoid arthritis (RA) and obesity are associated with asthma and allergic rhinitis. How other rheumatic conditions (OA, SLE) associate with asthma and allergy has not been determined. Methods: A retrospective chart review (2012-16) of adult patients with rheumatologic disorders (including RA, SLE, osteoarthritis) (n¼60) treated in a University based Allergy/Arthritis practice determined concurrent diagnosis of asthma and allergic rhinitis. Rheum. Disorders were categorized into immune (RA, SLE,
Introduction: ABPA is an exaggerated hypersensitivity response usually to Aspergillus fumigatus. CF subjects often have Aspergillus fumigatus colonization and ABPA because of impaired airway clearance. Systemic glucocorticosteroid is a treatment of choice for ABPA but when used chronically, results in significant side effects. Successful treatment with omalizumab, a monoclonal antibody against IgE, is reported in an ABPA-CF subject. Methods: A 15-year-old female with CF, pancreatic insufficiency, and asthma is found to have a serum eosinophilia, 770 cells/ mL (reference range 0 to 610) and elevated IgE,1123 IU/mL (reference range 0 to 100) during a hospital admission for pneumonia. A bronchoalveolar lavage culture grew both Pseudomonas aeruginosa and Aspergillus fumigatus. She remained symptomatic despite regular asthma treatment, tobramycin 300 mg/5 ml nebulized by inhalation twice/day, and oral pancreatic enzymes. Otherwise her past medical, social and family histories and review of systems were unremarkable. Results: A diagnosis of ABPA was made based on a positive Aspergillus fumigatus skin prick test (4+, wheal 10 mm and erythema 40 mm in diameter); specific IgE to Aspergillus fumigatus, 40.1 kU/L, (<0.34); IgG to Aspergillus fumigatus, 107 mg/L, (< 46); elevated IgE, 1123 IU/mL; bronchiectasis on CT; and asthma. Omalizumab 300 mg subcutaneous, every 2 weeks, was initiated. The subject had substantial improvement in respiratory symptoms and pulmonary function test results with a forced expiratory volume in first second (FEV1) increase of 300 ml from baseline at a three month follow-up visit. Conclusion: Omalizumab may be an alternative treatment for ABPA in CF subjects.
Case Presentation: We present a 32-year-old female with severe refractory atopic asthma, eosinophilic granulomatosis with polyangiitis (EGPA), allergic rhinoconjunctivitis with nasal polyposis who failed first and several second-line therapies for EGPA and atopy. Despite nasal polypectomies, aggressive nasal and pulmonary medication management including omalizumab, inhaled and intranasal corticosteroids, cyclophosphamide, mycophenolate mofetil, azathioprine, and rituximab; the patient continued to require chronic high dose steroid therapy. Allergen skin prick testing was positive to dust mites, cat, dog, and molds. Hoping to reduce steroid use and improve asthma management, monthly mepolizumab 100 mg subcutaneously was initiated with rapid