Allergic bronchopulmonary aspergillosis (ABPA) and omalizumab treatment

Author:

Pilar Mur Gimeno

Author address:

Spain

Full conference title:

European Academy of Allergy and Clinical Immunology Congress 2019

Date: 20 August 2020

Abstract:

Background
Standard treatment for ABPA includes systemic corticosteroids and oral antifungal agents. The role of omalizumab treatment in ABPA is not firmly established, however some recent studies have demonstrated clinically and statistically significant reductions in exacerbations. We present a clinical case successfully treated with omalizumab.

Method
A 65- year-old house wife diagnosed of non allergic mild-moderate perennial asthma since 2007, attended our outpatient consult referring persistent severe asthma not controlled with montelukast, aclidinium and formoterol+beclomethasone 200/6 every 8 h. She also had suffered Klebsiella pneumoniae exacerbations in 3 occasions and peripheral bronchiectasis. Since her baseline total IgE was 2153 KU/L (ImmunoCAP), we performed skin prick test to molds, specific Aspergillus IgE and IgG, Aspergillus precipitins, spirometrical monitoring and high resolution thoracic CT.

Results
The skin prick test performed to A. fumigatus: positive (5×6 mm). Specific Aspergillus IgG: 42.5 mg/L, specific IgE Aspergillus: 12.1 KU/L, r Asp f 6: 1.66 KU/L. Blood eosinophilia: 380 mm3, Aspergillus precipitins negative. Spirometric decline from mean baseline FEV1 75% of predicted to 61%.
The total IgE level decreased after starting oral steroids and itraconazol in October 2016 with clinical improvement until June 2018 (809 KU/L), when IgE levels increased progressively and we stopped the reduction of oral corticosteroids (prednisone 25 mg alternating days). Omalizumab 600 mg/15 days was then started and corticosteroids were latter ceased, 7 months later. All along the treatment with oral corticosteroids the patient has undergone the onset of diabetes mellitus, poor regulation in blood pressure, temporary iatrogenic Cushing syndrome and multiple sputum infections with different bacteria: K pneumonia, E coli, St aureus, Ps aeruginosa, Enterobacter cloacae, Acinetobacter… that were treated with antibiotics according to antibiogram.
The patient remains stable nowadays without exacerbations with a maintenance dose of 600 mg of omalizumab monthly. ACT score and FeNO show improvement with this treatment. Thoracic CT scan revealed reduced inflammation of the distal airways.

Conclusion
We describe a new case of serologic ABPA treated with omalizumab due to the partial response to oral corticosteroids. We consider that add-on omalizumab is an effective and well tolerated treatment in our patient with severe ABPA.

Abstract Number: TP0808

Link to conference website:

Link Conference abstract: 

EAACI 2019

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