Is it safe to continue Tezspire after hives and FEV1 70 %?

Question

Hello doctor,

My 14-year-old daughter started Tezspire injections three months ago for severe asthma. Before this, her asthma was poorly controlled despite high-dose Advair, Singulair, and frequent Prednisone bursts. She had two hospitalizations earlier this year.

Her pulmonologist noted an eosinophil count of 890 and a FeNO of 51 ppb. Since starting Tezspire, her asthma attacks have decreased, but she still needs her albuterol inhaler three to four times per week. After her most recent injection, she developed widespread hives and had difficulty breathing within an hour. The on-call physician said it was not anaphylaxis, but we are concerned about continuing treatment.

While her nighttime symptoms have improved, she still cannot tolerate physical activity like soccer without wheezing. Her most recent PFTs show an FEV1 of only 72 percent predicted.

How long should we continue Tezspire before determining if it is effective? Are these side effects typical, and should we be worried about the persistent lung function issues? Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and can understand your concern.

Tezspire (Tezepelumab) helps reduce asthma (a chronic condition that affects the airways in the lungs) inflammation, and it is encouraging that your daughter’s symptoms have improved. However, needing Albuterol three to four times a week shows her asthma is not fully controlled yet. It may take more time to see the full benefit, but if there is little change in the next few months, other treatments may need to be considered.

The hives (raised, itchy, red or skin-colored welts on the skin) and breathing difficulty after her last injection are concerning. While it may not have been a full anaphylaxis (severe allergic reaction), these symptoms are not typical and should be taken seriously. It is important to speak with her pulmonologist about whether Tezspire is still the right option.

An FEV1 (forced expiratory volume in one second) of 72 percent predicted points to moderate airflow limitation. Although Tezspire is helping, it might not be enough to fully control her asthma, especially since she still has trouble with physical activity like soccer.

Continue monitoring her symptoms closely, report all side effects to her doctor, and consider discussing alternative therapies if improvement stalls or side effects persist. Her treatment plan might need adjusting for better control and safety.

I hope this helps.

Kindly revert so I can assist you further.

Thank you.