Anti-IgE therapy for allergic bronchopulmonary aspergillosis in people with cystic fibrosis

Jat, Kana Ram; Walia, Dinesh Kumar; Khairwa, Anju

doi:10.1002/14651858.cd010288.pub4

Cited by 10 publications

(11 citation statements)

References 36 publications

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“…The optimal choice of treatment for ABPA with concomitant chronic respiratory infections might be more important for cases with cystic fibrosis; however, a multicenter, double-blinded, placebo-controlled trial of omalizumab in patients with cystic fibrosis and ABPA had been terminated prematurely due to poor enrollment. In addition, based on a systematic review, the use of omalizumab in patients with ABPA and cystic fibrosis is not recommended owing to the absence of validated data [25]. Further analysis with an increased number of cases would be required to fully elucidate the effects of omalizumab on the clinical and pathological changes of ABPA.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Omalizumab in Patients with Allergic Bronchopulmonary Aspergillosis Complicated by Chronic Bacterial Infection in the Airways

Tomomatsu

Oguma

Baba

et al. 2020

Int Arch Allergy Immunol

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Background: Allergic bronchopulmonary aspergillosis (ABPA) develops in the presence of predisposing conditions such as asthma and cystic fibrosis. Even ABPA accompanied by asthma is often complicated by chronic Pseudomonas aeruginosa or nontuberculous mycobacterial infection of the lower respiratory tract, rendering treatment with corticosteroids difficult. There have been several reports on the effectiveness of omalizumab, an anti-IgE antibody, in patients with ABPA. We analyzed the effectiveness and adverse effects of omalizumab in ABPA patients with chronic respiratory infections. Methods: Using our nationwide survey database and published case reports, we identified patients with severe asthma and ABPA who fulfilled the International Society for Human and Animal Mycology criteria and who had been treated with omalizumab. Exacerbation rates, control of symptoms, doses of oral corticosteroids, and pulmonary function were evaluated. Results: Among 25 patients with ABPA treated with omalizumab (median age 62 years, range 33–83 years), 12 patients had a chronic bacterial infection of the lower airways attributable to P. aeruginosa (n = 6) or nontuberculous mycobacteria (n = 6) at the initiation of omalizumab. Treatment with omalizumab reduced the frequency of exacerbations and systemic corticosteroid doses and improved pulmonary function. There were no significant adverse events or worsening of infection during treatment with omalizumab, except for injection-site reactions. Conclusions: Treatment with omalizumab was effective and safe in patients with ABPA, regardless of comorbid chronic respiratory tract infections.

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Section: Discussionmentioning

confidence: 99%

Effectiveness and Safety of Omalizumab in Patients with Allergic Bronchopulmonary Aspergillosis Complicated by Chronic Bacterial Infection in the Airways

Tomomatsu

Oguma

Baba

et al. 2020

Int Arch Allergy Immunol

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“…Omalizumab is more expensive than steroids and its use for ABPA is off-label, but it has the potential of a steroid sparing effect. Of note, a recent Cochrane Review concluded that there was not enough evidence in support of the efficacy and safety of omalizumab therapy for the treatment of ABPA in CF [ 57 ]. Other therapeutic monoclonal antibodies that target type 2 inflammation pathways, anti-IL-5 (mepolizumab) [ 58 ], and IL-4/IL13 mAb (dupilumab) [ 59 ] have shown positive effects in case series.…”

Section: Allergic Broncho-pulmonary Aspergillosis (Abpa)mentioning

confidence: 99%

Update on Respiratory Fungal Infections in Cystic Fibrosis Lung Disease and after Lung Transplantation

Renner

Nachbaur

Jaksch

et al. 2020

JoF

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Cystic fibrosis is the most common autosomal-recessive metabolic disease in the Western world. Impaired trans-membrane chloride transport via the cystic fibrosis transmembrane conductance regulator (CFTR) protein causes thickened body fluids. In the respiratory system, this leads to chronic suppurative cough and recurrent pulmonary infective exacerbations, resulting in progressive lung damage and respiratory failure. Whilst the impact of bacterial infections on CF lung disease has long been recognized, our understanding of pulmonary mycosis is less clear. The range and detection rates of fungal taxa isolated from CF airway samples are expanding, however, in the absence of consensus criteria and univocal treatment protocols for most respiratory fungal conditions, interpretation of laboratory reports and the decision to treat remain challenging. In this review, we give an overview on fungal airway infections in CF and CF-lung transplant recipients and focus on the most common fungal taxa detected in CF, Aspergillus fumigatus, Candida spp., Scedosporium apiospermum complex, Lomentospora species, and Exophiala dermatitidis, their clinical presentations, common treatments and prophylactic strategies, and clinical challenges from a physician’s point of view.

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“…Consequently, a recent Cochrane SR concluded that the use of omalizumab in CF patients with ABPA cannot be unequivocally recommended given the absence of validated data from randomized controlled trials. [ 92 ]…”

Section: Managementmentioning

confidence: 99%

“…[ 85 86 87 88 89 ] More evidence from larger randomized clinical trials will further substantiate its role in the management of ABPA. [ 92 ] Some other studies are currently underway to evaluate the efficacy of amphotericin B for the management of ABPA. One randomized controlled trial is exploring the role of nebulized liposomal amphotericin B in maintaining remission in patients with asthma and ABPA (NCT00787917).…”

Section: Future Directionsmentioning

confidence: 99%

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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Anti-IgE therapy for allergic bronchopulmonary aspergillosis in people with cystic fibrosis

Abstract: Editorial group: Cochrane Cystic Fibrosis and Genetic Disorders Group. Publication status and date: New search for studies and content updated (no change to conclusions), published in Issue 3, 2018.

Cited by 10 publications

References 36 publications

Effectiveness and Safety of Omalizumab in Patients with Allergic Bronchopulmonary Aspergillosis Complicated by Chronic Bacterial Infection in the Airways

Effectiveness and Safety of Omalizumab in Patients with Allergic Bronchopulmonary Aspergillosis Complicated by Chronic Bacterial Infection in the Airways

Update on Respiratory Fungal Infections in Cystic Fibrosis Lung Disease and after Lung Transplantation

Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

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