Pulmonary eosinophilic vasculitis with granulomas and benralizumab in children

Abstract

Letter to the Editor, Pulmonary eosinophilia represents a group of heterogeneous disorders consisting of lung disease and eosinophilia in the peripheral blood, alveoli, and/or pulmonary interstitium. 1 Subtype classifications include eosinophilic pneumonia (acute and chronic), allergic bronchopulmonary aspergillosis (ABPA), eosinophilic granulomatosis with polyangiitis (EGPA), drug or parasite-induced pulmonary eosinophilia, hypereosinophilic syndromes, and idiopathic pulmonary eosinophilia. 1 These classifications are based on adult populations, and therefore may not always be applicable to pediatric patients. As pulmonary eosinophilia rarely occurs in children and is largely described through case reports, its true incidence in pediatric populations is unknown. We report three cases of pediatric pulmonary eosinophilia identified at a single center within a 5-month period in 2019, all of which posed classification challenges. Benralizumab, an anti-interleukin-5 receptor alpha (IL-5Rα) monoclonal antibody, was used in all three cases under the impression of probable beneficial effect.

An Overview of Off-Label Use of Humanized Monoclonal Antibodies in Paediatrics

“…In Supplementary Table S5 , we report off-label use of Benralizumab in children with pulmonary eosinophilia, which represents a group of heterogeneous disorders consisting of lung disease and eosinophilia in the peripheral blood, alveoli and/or pulmonary interstitium [ 76 ].…”

Benralizumab: A novel treatment for the cutaneous features of paediatric eosinophilic granulomatosis with polyangiitis (pEGPA)

“…Our case supports the growing evidence for the use of benralizumab in the treatment of EGPA. Most studies have reported its efficacy in the treatment of patients with pulmonary eosinophilia and eosinophilic asthma 9,11 . It seems that benralizumab may also improve the skin lesions associated with EGPA, including in paediatric patients with this condition.…”

Mepolizumab: Therapeutic strategy for a pediatric patient with eosinophilic granulomatosis with polyangiitis

“…One month later, symptom control was achieved 18 . Interestingly, another humanized monoclonal antibody, benralizumab, which binds to IL‐5 receptors, has very recently been shown to impart beneficial effects in three pediatric patients with pulmonary eosinophilia 19 …”

“…18 Interestingly, another humanized monoclonal antibody, benralizumab, which binds to IL-5 receptors, has very recently been shown to impart beneficial effects in three pediatric patients with pulmonary eosinophilia. 19 Our patient's clinical diagnosis of EGPA in 2014 was based on the criteria published in 1990 by The American College of Rheumatology. Specifically, four of the following six criteria must be fulfilled and our patient got four of them (asthma, peripheral blood eosinophilia, pulmonary infiltrates, sinusitis).…”