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Updated: Apr 5, 2026
Murine Model of Allergen Induced Asthma
Published on: May 14, 2012
Steroid sparing effect of omalizumab in seropositive allergic bronchopulmonary aspergillosis
Keith T Beam1, Christopher A Coop
1Department of Medicine, San Antonio Military Medical Center, San Antonio, Texas, USA.
Background:
Allergic bronchopulmonary aspergillosis (ABPA) is a common serious hypersensitivity reaction to airway colonization with Aspergillus in patients with asthma or cystic fibrosis. While steroids are effective in controlling the respiratory symptoms of ABPA, they have many side effects that make them undesirable for long term use. Antifungals have been used to reduce dependency on systemic steroids but long term use can be limited by side effects and there is the possibility of developing resistance to azoles. Some clinicians have successfully used anti-immunoglobulin E (anti-IgE) therapy in various populations, though it is frequently added to antifungals.
Objective:
Further describe the utility of anti-IgE therapy for ABPA for patients unable to tolerate antifungals.
Methods:
We describe the case of a patient with serologic ABPA who did not tolerate therapy with antifungals but was able to significantly reduce her average daily steroid use while receiving anti-IgE therapy with omalizumab added to her other respiratory medications.
Results:
After therapy with omalizumab, our patient was able to reduce her need for daily corticosteroids by nearly 80%.
Conclusions:
Omalizumab may reduce corticosteroid dependence in patients with allergic bronchopulmonary aspergillosis for patients unable to tolerate antifungals, though use may be limited by cost. Additional studies are needed.
Insights
Omalizumab therapy helped a patient with allergic bronchopulmonary aspergillosis (ABPA) reduce steroid use by 80% when antifungals were not tolerated. This anti-immunoglobulin E (anti-IgE) treatment shows promise for managing ABPA symptoms.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Pharmacology
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is a serious Aspergillus-induced hypersensitivity reaction in asthma and cystic fibrosis patients.
- Systemic steroids manage ABPA symptoms but have significant long-term side effects.
- Antifungals reduce steroid dependency but can cause side effects and lead to azole resistance.
Purpose of the Study:
- To evaluate the effectiveness of anti-immunoglobulin E (anti-IgE) therapy, specifically omalizumab, for ABPA patients who cannot tolerate antifungal medications.
- To assess the potential of omalizumab in reducing corticosteroid dependence in this patient population.
Main Methods:
- A case study of a patient with serologic ABPA who experienced intolerance to antifungal therapy.
- Administration of omalizumab as an adjunct to existing respiratory medications.
- Monitoring of changes in daily corticosteroid usage.
Main Results:
- The patient achieved an approximately 80% reduction in daily corticosteroid requirements after initiating omalizumab therapy.
- Omalizumab was successfully used in a patient unable to tolerate standard antifungal treatments.
Conclusions:
- Omalizumab offers a potential therapeutic option for reducing corticosteroid dependence in ABPA patients intolerant to antifungals.
- Cost may be a limiting factor for omalizumab use.
- Further clinical studies are warranted to confirm efficacy and safety (ClinicalTrials.gov identifier: NCT00787917).
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