Anti-IgE therapy for management of recurrent ABPA exacerbations: successful outcome in 8 patients

Introduction: Allergic bronchopulmonary aspergillosis (ABPA), a complex hypersensitivity reaction occurring in patients with asthma or cystic fibrosis (CF) due to colonization of the airways with Aspergillus fumigatus. Patients with acute exacerbation of ABPA require steroid therapy, with or without antifungals for management. Patients with recurrent ABPA exacerbations have usually exhausted the above-mentioned armamentaria and bear the brunt of their inherent complications. We present a series of cases of recurrent ABPA exacerbations with asthma and without CF managed with Omalizumab, a humanized monoclonal anti IgE therapy Material and methods: ABPA patients with asthma and without CF on optimal therapy for asthma, presenting with recurrent exacerbations (minimum 2 exacerbations in past, requiring steroids therapy) were included. Total 8 patients (males 5, female 3), mean age 43years, mean duration of asthma management 9 years, mean duration of ABPA management 5 years were included. All had taken atleast 2 courses of oral steroids and one course of antifungals in past. Their mean anti IgE levels were 1380 IU/ml at onset of therapy with exacerbation. All were given Inj Omalizumab 300 mg subcutaneously every 14 days for six months and 300 mg monthly subsequently in addition to tapering doses of oral steroids at onset of therapy for a duration of 4 months. All are under follow up with mean duration of follow up of 3 years Results: Patients have remained steroid free and exacerbation free on follow up Conclusion: Anti IgE therapy prevents recurrent ABPA exacerbations, thus avoiding steroids and related side effects.