Allergic bronchopulmonary aspergillosis treated successfully for one year with omalizumab

Abstract

BackgroundCurrent therapy for allergic bronchopulmonary aspergillosis (ABPA) uses oral corticosteroids, exposing patients to the adverse effects of these agents. There are reports of the steroid-sparing effect of anti-IgE therapy with omalizumab for ABPA in patients with cystic fibrosis (CF), but there is little information on its efficacy against ABPA in patients with bronchial asthma without CF.ObjectiveTo examine the effects of omalizumab, measured by asthma control, blood eosinophilia, total serum immunoglobulin E (IgE), oral corticosteroid requirements, and forced expiratory volume spirometry in patients with ABPA and bronchial asthma.MethodsA retrospective review of charts from 2004–2006 of patients treated with omalizumab at an academic allergy and immunology practice in the Bronx, New York were examined for systemic steroid and rescue inhaler usage, serum immunoglobulin E levels, blood eosinophil counts, and asthma symptoms, as measured by the Asthma Control Test (ACT).ResultsA total of 21 charts were screened for the diagnosis of ABPA and bronchial asthma. Four patients with ABPA were identified; two of these patients were male. The median monthly systemic corticosteroid use at 6 months and 12 months decreased from baseline usage. Total serum IgE decreased in all patients at 12 months of therapy. Pre-bronchodilator forced expiratory vital capacity at one second (FEV1) was variable at 1 year of treatment. There was an improvement in Asthma Control Test (ACT) symptom scores for both daytime and nighttime symptoms.ConclusionsTreatment with omalizumab creates a steroid-sparing effect, reduces systemic inflammatory markers, and results in improvement in ACT scores in patients with ABPA.

Omalizumab: a new treatment option for allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

“…These factors might also be relevant in ABPA [Tanou et al 2014]. A significant steroid-sparing effect of omalizumab in children with severe asthma was recently documented in a therapeutic trial [Brodlie et al 2012 [Zirbes and Milla, 2008;Collins et al 2012]. However, it is an expensive off-label therapy and publications exist reporting cases in which omalizumab treatment was not successful.…”

The Effect of Omalizumab on Eosinophilic Inflammation of the Respiratory Tract in Patients with Allergic Asthma

“…Thus, the beneficial effect of omalizumab action was observed in bronchopulmonary aspergillosis [60,61], Churg-Strauss syndrome [62,63], eosinophilic pneumonia [64], Kimura disease [65], eosinophilic otitis media [66], and eosinophilic gastrointestinal syndromes [67].…”

The Use of Anti-IgE Therapy Beyond Allergic Asthma

“…37 A Cochrane meta-analysis attempted to evaluate the effects of omalizumab for ABPA in patients with cystic fibrosis but concluded that there were no studies that met inclusion criteria. 38 A retrospective analysis of 4 adult patients with stage IV ABPA (corticosteroid-dependent) treated with omalizumab for 12 months found that it was steroid sparing and reduced inflammatory markers and symptom scores. 39 …”