High Doses of Inhaled Corticosteroids Reduce Eosinophil Levels in Asthma

After careful consideration, the American Academy of Allergy, Asthma & Immunology canceled its annual meeting that was to take place in Philadelphia, Pennsylvania from March 13 to 16, because of concerns regarding the coronavirus disease 2019 (COVID-19) outbreak. Although the live events will not proceed as planned, our readers can still find coverage of research that was scheduled to be presented at the meeting.

High doses of inhaled corticosteroids (ICS) were associated with lower levels of eosinophils, which may interfere with the recommendation of some monoclonal antibodies in asthma treatment, according to study results intended to be presented at the 2020 Annual Meeting for the American Academy of Allergy, Asthma & Immunology (AAAAI).

The use of systemic corticosteroids in asthma reduces the eosinophil count. Patients with severe asthma must often use high doses of ICS long-term for disease management. The objective of this study was to evaluate the effect of ICS on peripheral eosinophils.

In this retrospective study, researchers examined the medical records of 58 patients with severe asthma at a tertiary center. Patients using oral corticosteroids were excluded. Data were evaluated on demographics, ICS dose, specific immunoglobulin E (IgE), total serum IgE, serum cortisol, and eosinophils.

In this study, the average ICS dose was 1682.8 µg/d, total serum IgE was 398.9 IU/mL, and 69% of patients had positive specific IgE. Average cortisol was 154.49 nmol/L (0-601.41 nmol/L), and average eosinophils were 252.1 cell/mm³ (0-1380 cell/mm³. No relationship was observed between ICS dose and serum cortisol. The higher the dose of ICS, the lower the level of eosinophils, given that 41.4% of patients had eosinophils <150 cell/mm³ and an inverse correlation was observed between ICS doses and levels of eosinophils (P =.029, r²=0.1).

The researchers concluded that although the Global Initiative for Asthma recommends the use of monoclonal antibodies in asthma step 5, higher doses of these agents may cause lower levels of eosinophils.

Reference

Franco P, Pereira G, Giavina-Bianchi P, Agondi R. Inhaled corticosteroid use and its implication in peripheral eosinophil level. J Allergy Clin Immunol. 2020;145(Suppl 2):AB28.

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