Allergic bronchopulmonary aspergillosis and omalizumab

Tillie‐Leblond, I.; Germaud, P.; Leroyer, Christophe; Têtu, L.; Girard, F.; Devouassoux, Gilles; Grignet, J.-P.; Prudhomme, A.; Dusser, Daniel; Wallaert, B.

doi:10.1111/j.1398-9995.2011.02599.x

Cited by 96 publications

(49 citation statements)

References 6 publications

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“…48–50 A trial of omalizumab in 16 patients with asthma and ABPA, demonstrated significant reductions in exacerbations and steroid requirement, although did not demonstrate improvement in spirometry. 51 Reduction in exacerbations of asthma and oral steroid requirements have been reported by others. 52 This potential adjunct in ABPA management, with a low side effect profile, warrants double blind, randomized, controlled trials.…”

Section: Management Of Allergic Bronchopulmonary Aspergillosismentioning

confidence: 62%

Allergic Bronchopulmonary Aspergillosis

Greenberger

Bush

Demain

et al. 2014

The Journal of Allergy and Clinical Immunology: In Practice

161

131

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There remains lack of agreement on diagnostic criteria and approaches to treatment of patients with Allergic Bronchopulmonary Aspergillosis (ABPA). The results of a survey of AAAAI members regarding these 2 issues are presented and compared for concordance with published recommendations. The literature was reviewed for pertinent reports and an electronic survey was conducted of AAAAI members and fellows regarding diagnostic criteria, numbers of patients evaluated for ABPA, and treatment approaches. From 508 respondents to the survey sent to 5155 U. S. physicians in the AAAAI database of members and fellows, 245 (48%) health professionals had treated at least 1 patient with ABPA in the previous year. For the diagnosis of ABPA, there was a difference in the threshold concentration of total serum IgE as 44.9% used ≥ 417 kU/L whereas 42.0% used ≥ 1000 kU/L. These findings suggest that ABPA might be underdiagnosed. Regarding pharmacotherapy, oral steroids were recommended for 97.1% of patients and oral steroids + inhaled corticosteroids + anti-fungal agent were utilized in 41.2% of patients. The armamentarium for treatment of ABPA includes oral corticosteroids as the initial treatment with inhaled corticosteroids used for management of persistent asthma. Azoles remain adjunctive. Published experience with omalizumab has been limited.

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Section: Management Of Allergic Bronchopulmonary Aspergillosismentioning

confidence: 62%

Allergic Bronchopulmonary Aspergillosis

Greenberger

Bush

Demain

et al. 2014

The Journal of Allergy and Clinical Immunology: In Practice

161

131

View full text Add to dashboard Cite

show abstract

“…reported the use of omalizumab in 16 adult patients with asthma and ABPA. [89] Omalizumab significantly reduced the need for steroids and the overall number of exacerbations in this study. In another study by Emiralioglu et al ., the use of omalizumab in six patients with CF and ABPA reduced the total serum IgE levels, improved respiratory symptoms, and decreased the need for steroids.…”

Section: Managementmentioning

confidence: 66%

Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

2017

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Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that often occurs in patients with asthma or cystic fibrosis (CF) and is characterized by a hypersensitivity response to the allergens of the fungus Aspergillus fumigatus. In patients with CF, growth of A. fumigatus hyphae within the bronchial lumen triggers an immunoglobulin E (IgE)-mediated hypersensitivity response that results in airway inflammation, bronchospasm, and bronchiectasis. In most published studies, the prevalence of ABPA is about 8.9% in patients with CF. Since the clinical features of this condition overlap significantly with that of CF, ABPA is challenging to diagnose and remains underdiagnosed in many patients. Diagnosis of ABPA in CF patients should be sought in those with evidence of clinical and radiologic deterioration that is not attributable to another etiology, a markedly elevated total serum IgE level (while off steroid therapy) and evidence of A. fumigatus sensitization. Management of ABPA involves the use of systemic steroids to reduce inflammation and modulate the immune response. In patients who do not respond to steroids or cannot tolerate them, antifungal agents should be used to reduce the burden of A. fumigatus allergens. Recent studies suggest that omalizumab may be an effective option to reduce the frequency of ABPA exacerbations in patients with CF. Further randomized controlled trials are needed to better establish the efficacy of omalizumab in managing patients with CF and ABPA.

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“…As an increase in local production of IgE is implicated in the pathophysiology of CRSwNP and AFRS [5,6] omalizumab may have a potential benefit in these patients. Furthermore, given the pathophysiological similarity between ABPA and AFRS and recent case reports [14][15][16][17][18] and case series [19] demonstrating improvement in the clinical outcome of omalizumab in ABPA patients, the efficacy of omalizumab in patients with AFRS should be explored. Hence in this study, we aim to compare the sinonasal outcomes before and after omalizumab therapy in patients with refractory AFRS and moderate to severe asthma.…”

Section: Introductionmentioning

confidence: 98%

“…Omalizumab is a humanized monoclonal anti-IgE antibody that has been shown to be an effective adjuvant therapy in severe atopic asthma, allergic rhinitis, CRS with nasal polyposis (CRSwNP) and asthma and ABPA [11][12][13][14][15][16][17][18][19][20][21]. Omalizumab decreases free IgE levels by binding to free circulating IgE.…”

Section: Introductionmentioning

confidence: 99%