D2.429 - Biologic Therapy in Occupational Asthma: A Multicenter Retrospective Study on Treatment Outcomes and Occupational Impact

Biologic treatment for occupational asthma is rare. Workplace exposure to allergens or irritants can trigger airway inflammation, respiratory symptoms, and even bronchial asthma. Standard therapy includes inhaled corticosteroids and bronchodilators, while severe cases often require systemic corticosteroids. Biologics help to avoid the adverse effects of systemic corticosteroids.

This study analyzed cases of occupational asthma treated with biologics using databases from three centers in Germany, Italy, and Ukraine.

Nine patients were identified (5 from Germany, 2 from Italy, 2 from Ukraine), of whom 3 received benralizumab, while 2 each were treated with mepolizumab, dupilumab, and omalizumab. The patients occupational backgrounds, includes 2 cleaners, 2 hairstylists, 1 foundryman, 1 dairy worker, 1 baker, 1 pasta producer, 1 farmer. 66.7% (6 patients) had never smoked, 33.3% (3 patients) were former smokers. Rhinoconjunctivitis was present in 6 patients (66.7%). Before biologic therapy, patients required an average daily prednisolone dose of 3.83 mg (SD ± 2.52), which was successfully discontinued in all cases. The annual exacerbation rate significantly decreased from 3.22 (SD ± 0.97) to 0.22 (SD ± 0.44) (p < 0.05). The eosinophil count decreased from 0.467 (SD ± 0.278) to 0.132 (SD ± 0.128) (p = 0.0059). Lung function (FEV₁) improved from 71.96% (SE ± 10.30) to 80.83% (SE ± 8.68), but this change was statistically not significant (p = 0.1602). The FVC percentage increased from 85.51% (SE ± 9.62) to 90.92% (SE ± 6.62), without statistical significance (p = 0.34). The ACT score improved from 8.67 (SD ± 2.83) to 17.00 (SD ± 5.10), p = 0.0018. 55.6% of patients had changed their occupation.

Biologic therapy for occupational asthma remains uncommon but shows potential in reducing corticosteroid dependence and exacerbations while improving asthma control. Although lung function changes were not statistically significant, the ACT score improvements suggest better symptom management. More than half of the patients changed their occupation, underscoring the importance of workplace exposure in disease progression. Further studies with larger cohorts are needed to establish clearer treatment guidelines.

*IF and AH contributed equally to the study.