Adalimumab and etanercept induced asthma

Abstract

Tumor necrosis factor (TNF) alpha has been implicated in asthmatic airway inflammation. The pathophysiologic mechanisms of asthma induced by anti-TNF-alpha treatment are unknown.

We report the cases of two patients who developed asthma after starting anti-TNF –alpha treatment of Rheumatoid Arthritis(RA). Cases had no personal or family history of asthma or atopy and had never smoked. The diagnosis of asthma was made on the basis of recurrent wheezing, breathlessness and coughing in accordance with the definition of the American Thoracic Society. No other causes of dyspnea were found. Asthma treatment was started and symptoms, physical examination and Pulmonary Function Test findings were completely recovered.

Case 1. A 49-yr-old lady with a history of seropositive RA was treated with Etanercept for 6 months. Prior to this she had no personal or family history of asthma or atopy and had never smoked. Within 6 months of starting Etanercept, she developed a diurnal wheeze with shortness of breath, cough and sneezing and diagnosis of asthma was made.

Case 2. A 54-yr-old male with a history of seropositive RA was treated with Adalimumab. Prior to this he had no personal or family history of asthma or atopy and had never smoked. Within 3 months of starting Adalimumab, he developed a diurnal wheeze with shortness of breath and diagnosis of asthma was made.

The chronology of events and absence of previous respiratory disease suggested an adverse reaction to Adalimumab and Etanercept. Asthma appears to be a definite but rare side effect of anti-TNF blokade. We recommend careful observation for the RA patients receiving Adalimumab or Etanercept. The use of these drugs is increasing and the adverse effects may become more prevalent in the future.