Allergic bronchopulmonary aspergillosis treated successfully for one year with omalizumab

Abstract

Background

Current 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.

Objective

To 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.

Methods

A 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).

Results

A 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.

Conclusions

Treatment with omalizumab creates a steroid-sparing effect, reduces systemic inflammatory markers, and results in improvement in ACT scores in patients with ABPA.

Keywords:

• allergic bronchopulmonary aspergillosis
• omalizumab
• asthma

Acknowledgments

Dr Jennifer Collins, MD organized the data and was the primary author for this paper. Dr G deVos, MD, MS contributed to statistical analysis and revisions. Drs G Hudes, MD, PhD and D Rosenstreich, MD provided input into the organization of this paper, chart review, editorial advice, and information on patients with allergic bronchopulmonary aspergillosis. Dr Gopei Yu provided statistical advice. Drs Vivian Chou and Anita Gewurz provided editorial advice and information regarding one of their patients with ABPA who was treated with omalizumab.

Disclosure

The authors report no conflicts of interest in this work.