Abstract
Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder occurring in response to Aspergillus fumigatus that can complicate the course of asthma and cystic fibrosis. Here we present a case of acute ABPA without central bronchiectasis, a case of chronic active ABPA with central bronchiectasis, and a case of severe relapsing ABPA with central bronchiectasis. All three were initially treated with corticosteroids and antifungal agents but had an incomplete response. These patients were then treated with anti-IgE therapy with omalizumab before being switched to the anti-IL5R agent benralizumab. They responded well to both agents. These case reports highlight the potential role of omalizumab and benralizumab in the treatment of ABPA, but further studies are required to evaluate the effectiveness of these medications. Longer follow-up periods and objective measurements of the impact of treatment are necessary.
Highlights
Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically mediated pulmonary disorder that can complicate the course of asthma and cystic fibrosis
It is a hypersensitivity reaction mediated by antigens released by Aspergillus, which colonize the airways of susceptible subjects
Given the extremely high immunoglobulin E (IgE) levels seen in ABPA, the maximum dose of omalizumab was indicated in these patients, requiring hospital visits every 2 weeks for administration
Summary
Allergic bronchopulmonary aspergillosis (ABPA) is an immunologically mediated pulmonary disorder that can complicate the course of asthma and cystic fibrosis. This resulted in clinical improvement, with a reduction in salbutamol reliever use (four times per day to once per day) and a reduction in exacerbation frequency with no exacerbations in the 6-month period after commencing omalizumab Her total IgE level reduced to 866 IU/mL (Figure 1), her eosinophil count was 0.3 × 109/L, and maintenance corticosteroid therapy was weaned and discontinued. Six months later, she was switched to benralizumab (30 mg every 8 weeks) to decrease the frequency of her visits to hospital.
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