Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is an eosinophilic pulmonary disorder caused by a hypersensitivity reaction to Aspergillus fumigatus that manifests with uncontrolled asthma, peripheral blood eosinophilia, and radiological findings, such as mucus plugging. Early diagnosis and proper treatment of ABPA are essential to prevent irreversible lung damage such as pulmonary fibrosis and bronchiectasis and improve the quality of life of patients. Beside inhaled medication for asthma, anti-inflammatory agents (i.e., systemic glucocorticoids) and antifungal agents are the mainstay treatment of ABPA. The goal of therapy using glucocorticoids and antifungal agents is to suppress the immune hyperreactivity to A. fumigatus and attenuate the fungal burden. Since the systemic glucocorticoid therapy may lead to serious adverse effects including osteoporosis, avascular necrosis, myopathy, cushingoid appearance, hypertension, insomnia, and increased risk of infection, a glucocorticoid-sparing agent could be considered. Mepolizumab is a humanized monoclonal antibody that binds to interleukin-5, which is the key mediator for eosinophil differentiation, activation, migration, and survival. We review eight cases of ABPA treated successfully with mepolizumab. Treatment with mepolizumab was not restricted to the total immunoglobulin E level, the limiting factor for omalizumab in ABPA. In addition, mepolizumab therapy improved forced expiratory volume in one second, radiological findings, and patient quality of life.
Highlights
BackgroundAllergic bronchopulmonary aspergillosis (ABPA) was first described in 1952 [1]
ABPA is an eosinophilic pulmonary disorder caused by a hypersensitivity reaction to Aspergillus fumigatus, which manifested with uncontrolled asthma, peripheral blood eosinophilia, and radiological findings such as mucus plugging [2]
All patients experienced uncontrolled asthma and were diagnosed with ABPA based on eosinophilia, proven the presence of A. fumigatus, characteristic imaging findings, elevated total IgE levels, and eosinophilia [14]
Summary
BackgroundAllergic bronchopulmonary aspergillosis (ABPA) was first described in 1952 [1]. Beside inhaled medication for asthma, anti-inflammatory agents (i.e., systemic glucocorticoids) and antifungal agents are the mainstay treatment of ABPA. Five stages have been described for ABPA in patients with asthma: acute (I), remission (II), exacerbation (III), steroid-dependent asthma (IV), and end-stage fibrotic (V) [4]. Systemic glucocorticoids such as prednisone with an initial dose of 0.5 mg/kg/day are considered the core of treatment of ABPA in the acute phase. Antifungal therapy with itraconazole or voriconazole is considered for patients who are unable to taper systemic glucocorticoids [7]. Mepolizumab is a humanized monoclonal antibody that binds to interleukin-5 (IL-5), which is the key
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
