There are numerous biologics for treating patients with severe asthma. A cost-effective method for selecting the most appropriate biologic therapy for a patient is thus important. Bronchoscopy-guided bronchial epithelium sampling may provide information for determining the type of inflammation in the airways of severe asthma patients through immunochemical analysis and thus help clinicians select the correct biologics. We report the case of a female with severe asthma and eosinophilia who initially responded to omalizumab treatment. She developed an allergic reaction after four injections of omalizumab. Omalizumab desensitization was successfully conducted. To select an appropriate biologic agent after this hypersensitivity episode, we performed bronchoscopy-guided bronchial epithelium sampling. Omalizumab treatment was resumed based on the findings of immunohistochemical staining after a successful desensitization procedure, leading to long-term control of her severe asthma. Selecting an adequate biologic agent for severe, uncontrolled asthma is a challenge in clinical medical practice. Although phenotypes, blood eosinophils, and serum IgE levels have been proposed for use as a reference, there is a dissociation between the blood immune-cell level and the airway epithelium immune reaction, as confirmed in previous studies. Airway epithelium immunohistochemistry staining for targeted immune cells has been used to determine various types of airway inflammation; however, this technique is rarely used in a clinical setting. Previous studies have revealed the relative safety of performing bronchoscopy biopsies for patients with severe asthma. Among the sampling techniques used for tissue diagnosis, including nasal biopsies, nasal or bronchial brushing, and bronchoalveolar lavage, bronchoscopy-guided bronchial epithelium sampling provides more accurate information about the epithelial and inflammatory cells in the tissue context. It is thus a powerful tool for selecting the most suitable biologics in difficult clinical conditions.

中文翻译：

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支气管镜引导下支气管上皮取样作为选择严重哮喘患者最佳生物治疗的工具：病例报告

有许多用于治疗严重哮喘患者的生物制剂。因此，为患者选择最合适的生物疗法的经济有效的方法非常重要。支气管镜引导的支气管上皮取样可提供信息，通过免疫化学分析确定重症哮喘患者气道炎症类型，从而帮助临床医生选择正确的生物制剂。我们报告了一例最初对奥马珠单抗治疗有反应的患有严重哮喘和嗜酸性粒细胞增多症的女性。她在四次注射奥马珠单抗后出现过敏反应。成功进行了奥马珠单抗脱敏。为了在这次超敏反应后选择合适的生物制剂，我们进行了支气管镜引导下的支气管上皮取样。奥马珠单抗治疗基于成功脱敏程序后的免疫组织化学染色结果进行总结，从而使她的严重哮喘得到长期控制。为严重、不受控制的哮喘选择合适的生物制剂是临床医学实践中的一项挑战。虽然表型、血液嗜酸性粒细胞和血清 IgE 水平已被提议用作参考，但正如先前的研究所证实的那样，血液免疫细胞水平与气道上皮免疫反应之间存在分离。靶向免疫细胞的气道上皮免疫组织化学染色已被用于确定各种类型的气道炎症；然而，这种技术很少用于临床环境。以前的研究已经揭示了对严重哮喘患者进行支气管镜活检的相对安全性。在用于组织诊断的取样技术中，包括鼻活检、鼻或支气管刷洗和支气管肺泡灌洗，支气管镜引导的支气管上皮取样可提供有关组织环境中上皮细胞和炎症细胞的更准确信息。因此，它是在困难的临床条件下选择最合适的生物制剂的有力工具。