title: Asthma unmasked with tumor necrosis factor-α-blocking drugs.
abstract: We report five cases of asthma unmasked by anti-tumor necrosis factor (TNF)-α-blocking drugs. Asthma symptoms appeared within an average of 4 months (range 1-24 months) after starting the anti-TNF-α treatment for inflammatory disease. The patients did not appear to be predisposed to asthma except for one patient who had asthma during childhood. Four patients stopped anti-TNF-α-blocking drugs with an improvement of symptoms within 1 to 5 months. In the patient with a history of childhood asthma, respiratory symptoms recurred when another anti-TNF-α therapy was started. Asthma control was achieved with inhaled steroids, allowing anti-TNF-α treatment to continue. The biotherapy was maintained for the fifth patient in association with inhaled steroids. The pathophysiologic mechanisms are unknown but are probably more complex than the T helper 1/T helper 2 imbalance suggested in the literature, and further studies are required.
authors.affiliation: Service de pneumologie et exploration fonctionnelle respiratoire, CHRU Tours, Tours, France; Unité INSERM U618, Faculté de médecine, Université François Rabelais, Tours, France. Electronic address: guillel@free.fr.
authors.forename: Laurent
authors.initials: L
authors.lastname: Guilleminault
authors.affiliation: Service de pneumologie et exploration fonctionnelle respiratoire, CHRU Tours, Tours, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Carré
authors.affiliation: Hôpital Bretonneau, Department of Clinical Pharmacology/Regional Centre of Pharmacovigilance, CHRU Tours, Tours, France.
authors.forename: Frédérique
authors.initials: F
authors.lastname: Beau-Salinas
authors.affiliation: Service de Pneumologie, APHP, Hôpital Bichat-Claude-Bernard, Paris, France; Unité INSERM U700, Faculté de X. Bichat, Université René Descartes, Paris, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Taillé
authors.affiliation: Service de rhumatologie, APHP, Hôpital Bichat-Claude-Bernard, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Dieudé
authors.affiliation: Service de Pneumologie, APHP, Hôpital Bichat-Claude-Bernard, Paris, France; Unité INSERM U700, Faculté de X. Bichat, Université René Descartes, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Crestani
authors.affiliation: Service de pneumologie et exploration fonctionnelle respiratoire, CHRU Tours, Tours, France; Unité INSERM U618, Faculté de médecine, Université François Rabelais, Tours, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Diot
authors.affiliation: Service de pneumologie et exploration fonctionnelle respiratoire, CHRU Tours, Tours, France; Unité INSERM U618, Faculté de médecine, Université François Rabelais, Tours, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Marchand-Adam
mesh_terms: D000068879:Adalimumab; D000280:Administration, Inhalation; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D000069285:Infliximab; D008297:Male; D008875:Middle Aged; D012216:Rheumatic Diseases / Q000188:drug therapy; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D013256:Steroids; D014409:Tumor Necrosis Factor-alpha; D000069285:Infliximab; D000068879:Adalimumab