• Vladislava Ada Grueva Karanfilova University Clinic of Pulmonology and Allergology – Skopje
  • Elena Grueva Nastevska University Clinic of Cardiology – Skopje


Th2-high-related inflammation, severe asthma, nasal polyposis, positive SPT and High Levels of IgE


Asthma is a heterogeneous chronic inflammatory disease of the airways characterized by chronic airway inflammation bronchoconstriction, airway hyperresponsiveness, and mucus hypersecretion. Typical symptoms are wheezing, shortness of breath, chest tightness, and cough with variable expiratory flow limitation. Asthma affects approximately 300 million people worldwide. About 5–10% of all asthmatics suffer from severe or uncontrolled asthma, associated with increased mortality and hospitalization, reduced quality of life, and increased health care costs11. Endotypes were recently described, aiming at defining asthma entities according to identified or suspected mechanisms associated with and putatively leading to the disease with variable clinical presentation (phenotypes)12. They include parameters such as clinical characteristics, biomarkers, genetics, histopathology, lung physiology and response to therapy13. Asthma endotypes may be broadly regarded as type 2 (T2) high or T2-low according to Severe Asthma Research Program (SARP), the Unbiased Biomarkers for the Prediction of Respiratory Disease Outcome (U-BIOPRED), and Airways Disease endotyping for Personalized Therapeutics (ADEPT)14. Th2-high-related inflammation is the main characteristic of Th2-high phenotypes, together with early-onset allergic asthma and late-onset eosinophilic asthma. Neutrophilic asthma and obesity-related asthma are considered Th2-low phenotypes. In allergic asthma, the allergens presented to naive CD4+ T cells by dendritic cells (DCs) induce differentiation into Th2 cells15. In nonallergic eosinophilic asthma, respiratory epithelium-derived cytokines and chemokines, also called alarmins, are released in response to various harmful triggers (air pollutants, microbes, or glycolipids), which then bind to the receptors on type-2 innate lymphoid cells (ILC2s). Both of these types of activated cells (Th2 cells and ILC2s) produce cytokines such as IL-4, IL-5, and IL-13, which are the principal effectors of type 2 inflammation. IL-5 is the most specific trigger for eosinophils, IL-4 and IL-13, which share a common receptor subchain (IL-4R?), induce allergen-specific immunoglobulin (Ig) E synthesis. IgE, through its interaction with the specific receptor Fc?RI (expressed in different immune cells), promotes the release of mediators that are responsible for functional and structural modifications of the bronchial wall16. Biological therapy has been demonstrated to be effective at reducing asthma exacerbations, maintaining control over asthma symptoms, and reducing the need for steroid bursts while preventing the well-known adverse events associated with steroid use.171819. GINA final report 2019 on severe asthma, define difficult to treat and severe asthma as a concept of an uncontrolled asthma, which includes one or more of: poor symptom control (frequent symptoms or reliever use, limited activity or night waking) or frequent exacerbation (>2 /year requiring oral corticosteroids, or serious exacerbation >1/year requiring hospitalization. Taking into account the heavy burden of symptoms, exacerbations and most serious medication side-effects, timely and prompt assessment and evaluation of the patients with uncontrolled asthma is of great importance2021.
In this paper we will review treatment options and dilemmas of a 63 years old woman, with long standing severe asthma (> 15 years), chronic allergic rhinosinusitis and nasal polyposis. The patient was receiving regular asthma treatment, according to GINA step 4 and step 5 plus additional anti-allergy medications. She was experiencing frequent symptoms and she was using Salbutamol as a reliever >2 times per week, and had serious exacerbation which required hospitalization 2-3 times per year and treatment with i.v corticosteroids and on OSC on discharge




How to Cite

Grueva Karanfilova, V. A., & Grueva Nastevska, E. (2021). THERAPEUTIC DILEMMA IN A PATIENT WITH LONGSTANDING SEVERE ASTHMA AND HIGH LEVELS OF TOTAL IGE. KNOWLEDGE - International Journal, 44(2), 131–136. Retrieved from

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