Successful Treatment with Benralizumab for Allergic Bronchopulmonary Aspergillosis That Developed after Disastrous Heavy Rainfall in Western Japan

Pulmonary Aspergilloma and Allergic Bronchopulmonary Aspergillosis Following the 2018 Heavy Rain Event in Western Japan

“…In cases where surgical resection is difficult, long-term steroid therapy is necessary, and there is concern that aspergilloma may worsen. There has been one case of improvement in ABPA with the administration of benralizumab (anti-IL-5 receptor antibody) to avoid systemic steroid administration ( 16 ). In addition, there was a report suggesting that mepolizumab (anti-IL-5 antibody) may be effective in refractory ABPA cases ( 17 ).…”

Reply to "Benralizumab as a First-line Treatment for ABPA: Is It Really Indicated?"

“…The Authors' Reply We read with interest the insightful comments by Agarwal et al regarding our recent paper ( 1 ), “Successful treatment with benralizumab for allergic bronchopulmonary aspergillosis that developed after disastrous heavy rainfall in Western Japan.” They suggested triazole antifungal agents as attractive alternative therapeutic options for allergic bronchopulmonary aspergillosis (ABPA) when glucocorticoid use was difficult, as evidenced by the results of their clinical trials ( 2 , 3 ). However, we recognize that antifungal agents are not highly recommended and that they should be introduced only after carefully evaluating their desirable and undesirable effects and the individual patient’s condition, as reported in a systematic review by Moreira et al ( 4 ).…”

“…We avoided systemic corticosteroid administration in our patient because she not only refused it but also had mild diabetes and obesity, a condition that carried a high risk of adverse events ( 1 ). We believe that benralizumab administration was appropriate for the following reasons.…”

“…The Authors' Reply We read with interest the insightful comments by Agarwal et al regarding our recent paper (1), "Successful treatment with benralizumab for allergic bronchopulmonary aspergillosis that developed after disastrous heavy rainfall in Western Japan." They suggested triazole antifungal agents as attractive alternative therapeutic options for allergic bronchopulmonary aspergillosis (ABPA) when glucocorticoid use was difficult, as evidenced by the results of their clinical trials (2,3).…”

Benralizumab as a First-line Treatment for ABPA: Is It Really Indicated?

“…To the Editor We read with interest the article “Successful Treatment with Benralizumab for Allergic Bronchopulmonary Aspergillosis that Developed after Disastrous Heavy Rainfall in Western Japan” wherein the authors have used benralizumab as a first-line treatment for allergic bronchopulmonary aspergillosis (ABPA) ( 1 ). While glucocorticoids are the first-line treatment for ABPA, they were not given in the index case due to a fear of adverse effects related to glucocorticoids.…”