Benralizumab for Life-threatening Exacerbations of Eosinophilic Asthma: A Case Series
Bibliographic record
Abstract
Abstract Introduction Benralizumab, an anti-interleukin-5 receptor-α monoclonal antibody, is approved for maintenance therapy in severe eosinophilic asthma. Few reports have described benralizumab use in acute eosinophilic exacerbations. We present two patients with life-threatening exacerbations who experienced striking clinical improvement with benralizumab. Case description Patient 1 is a 31-year-old man known for mild asthma on as-needed fluticasone and salbutamol. His symptoms had markedly worsened following sustained occupational diisocyanate spray paint exposure, culminating in him presenting in respiratory distress following a viral illness. He was tachycardic (118/min), hypoxemic (SpO2 88%), and hypercapnic (pCO2 47.1 mmHg). Spirometry revealed forced expiratory volume in one second (FEV1) 1.69 L (36% predicted) and peak expiratory flow (PEF) 2.92 L/s (30% predicted). Blood eosinophil count (BEC) was 520 cells/μL. Patient 2 is a 37-year-old pregnant woman who presented at 27 weeks gestation in respiratory distress. She was known for severe, oral corticosteroid-dependent eosinophilic asthma with multiple exacerbations annually despite triple inhaled therapy, prednisone 10 mg daily, and montelukast. She was hypoxemic (SpO2 89%) with FEV1 1.09 L (31% predicted) and PEF 3.43 L/s (47% predicted). Investigations revealed BEC 430 cells/μL, pCO2 27.9 mmHg, and lactate 2.5 mmol/L. Despite short-acting bronchodilators, intravenous methylprednisolone, and magnesium sulfate, both patients remained dyspneic at rest and required 5 L/min supplemental oxygen to maintain SpO2 >90%. They both tested positive for rhinovirus. Imaging revealed no pneumonia or pulmonary embolus. Given elevated BEC suggesting that eosinophil-mediated inflammation was driving their exacerbations, benralizumab was administered. Within 24 hours, both patients were weaned off oxygen and reported significant symptomatic improvement. Patient 1's repeat spirometry confirmed markedly increased PEF and FEV1 (Figure 1). Both patients were discharged five days following benralizumab with near-normal spirometry. Discussion These patients with life-threatening eosinophilic asthma exacerbations experienced prompt and dramatic improvement in symptoms, oxygenation, and lung function following single-dose benralizumab. Benralizumab generates antibody-dependent cellular cytotoxicity against eosinophils, causing rapid and near-complete depletion of blood and tissue levels. This process is hypothesized to explain the brisk clinical response in patients with eosinophil-mediated exacerbations. Our case series adds to the growing literature, including a recently presented randomized trial, demonstrating the positive effects of benralizumab in the treatment of acute eosinophilic respiratory exacerbations in reducing treatment failure. We emphasize that our patients had rapid clinical improvement despite near-fatal exacerbations refractory to usual management, suggesting that benralizumab could have an important role as rescue and potentially first-line therapy in this population.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".