title: Asthma and orbital immunoglobulin G4-related disease.
abstract: BACKGROUND
  An association has been suggested between asthma and orbital immunoglobulin G4-related disease (IgG4-RD).
  
  
  OBJECTIVE
  To explore this association, including asthma characteristics and risk factors.
  
  
  METHODS
  A retrospective, computer-assisted search identified patients with orbital IgG4-RD seen at Mayo Clinic in Rochester, Minnesota from 1997 to 2014. Asthma prevalence and its related clinical and radiologic characteristics were studied.
  
  
  RESULTS
  Thirty-one patients (17 men) with biopsy-proven orbital IgG4-RD were identified. Mean age at diagnosis was 54.3 years (SD 11.0 years). Median duration from onset of orbital symptoms to IgG4-RD diagnosis was 1.96 years (range 0.1-31.8 years). Twenty-two patients (71%) were not smokers, 6 (19%) were former smokers, and 3 (10%) were current smokers. Sixteen patients (52%) had asthma. Three patients had childhood asthma onset, and median age at asthma onset in the 7 patients with data available was 56 years (range 15-62 years). In this cohort, the most common findings at chest computed tomography were mediastinal and hilar lymphadenopathy (44%), linear scarring (20%), and nodules and bronchial wall thickening (16%). Bronchial wall thickening correlated with presence of asthma. Chronic sinusitis (94%) was most commonly associated with asthma. Serum IgG4 was markedly increased in patients with asthma (median 195.0 mg/dL, range 31.8-1,790.0 mg/dL) vs patients without asthma (median 78.9 mg/dL, range 7.7-166.0 mg/dL; P = .02). Treatment was commonly prednisone and then rituximab; rituximab helped control asthma in most cases. Two deaths were reported (median follow-up 4.2 years).
  
  
  CONCLUSIONS
  Asthma is commonly associated with orbital IgG4-RD and generally manifests as adult-onset bronchial wall thickening seen at computed tomography, increased serum IgG4 levels, and good rituximab response.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota. Electronic address: baqir.misbah@mayo.edu.
authors.forename: Misbah
authors.initials: M
authors.lastname: Baqir
authors.affiliation: Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.
authors.forename: James A
authors.initials: JA
authors.lastname: Garrity
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Robert
authors.initials: R
authors.lastname: Vassallo
authors.affiliation: Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Witzig
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jay H
authors.initials: JH
authors.lastname: Ryu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007105:Immune Complex Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D007074:Immunoglobulin G / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009916:Orbital Diseases / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D015995:Prevalence; D012189:Retrospective Studies; D000069283:Rituximab / Q000627:therapeutic use; D016019:Survival Analysis; D014481:United States; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G; D000069283:Rituximab