Case Report
Severe Exacerbation of Asthma: A New Side Effect of Interferon-α in Patients With Asthma and Chronic Hepatitis C

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Interferon-α is used by physicians to treat numerous common medical disorders; however, therapy is often limited by side effects. Pulmonary complications, such as interstitial pneumonitis and bronchiolitis obliterans organizing pneumonia, have been described in patients receiving interferon-α therapy. Exacerbation of asthma induced by subcutaneous administration of interferon-α has not been previously reported. We describe two patients with mild asthma in whom treatment with interferon-α for chronic hepatitis C resulted in exacerbation of the underlying asthma. The severe asthmatic symptoms resolved promptly after use of interferon-α was discontinued and corticosteroid therapy was initiated. Repeated treatment with interferon-α several months later resulted in a rapid, more severe exacerbation of asthma in both patients. Patients undergoing therapy with interferon-α, especially those with chronic asthma, should be monitored closely for pulmonary symptoms. If these symptoms develop, patients should be instructed to discontinue use of interferon-α and seek medical attention immediately.

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Case 1

A 57-year-old man was referred to the gastroenterology clinic for evaluation of chronic hepatitis C, cryoglobulinemia, and membranoproliferative glomerulonephritis. Physical examination revealed a thin man with no jaundice and findings of tender hepatomegaly, lower extremity edema (3+), and palpable purpura of both lower extremities. Results of the cardiac and pulmonary examinations were normal.

The patient's past medical history was remarkable for hypertension and mild asthma. He had never been

DISCUSSION

Interferons are naturally occurring substances that were initially described for their ability to interfere with viral replication. They are a family of protein molecules (α, β and γ) that are produced in response to a wide range of stimuli. Interferons activate target cells by binding to specific receptors on the cell membrane. This results in the synthesis of effector proteins that mediate the varied actions of interferon.8 Interferon-α was the first cytokine to be synthesized by recombinant

SUMMARY

Interferon-α is being used more frequently and has been approved by the Food and Drug Administration for numerous common medical disorders. Asthma, an extremely common disorder, affects between 9 and 12 million people in the United States.24 Fortunately, pulmonary complications associated with interferon-α therapy are uncommon. We believe that interferon-α caused an exacerbation of asthma in our two patients who had relatively quiescent pulmonary disease. All physicians and patients should be

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