IgE immunadsorption in allergic bronchopulmonary aspergillosis: A pilot study

Siva Mahendran, Rosemary Ebling, Mohammad Ibrahim, Tariq Sethi

Abstract: 

ABPA is a hypersensitivity immune response to Aspergillus fumigatus characterised by a raised total and specific IgE. Current treatments including corticosteroids are associated with adverse side effects. Anti-IgE Omaluzimab has been successfully used in ABPA providing a scientific rationale to targeting IgE but has not been established in large scale clinical trials.

Immunoadsorption (IA) selectively removes immunoglobulins from plasma and has gained clinical validity in a range of antibody-mediated diseases. Ig-E selective IA has been successful in severe atopic dermatitis (Reich, K. et al JACI 2016; Mar 15) which is also characterised by high IgE. However IA has not been evaluated before in Asthma and ABPA.

5 patients (mean 52 years) with established ABPA were scheduled to undergo 10 IA treatments using the Life 18 (Miltenyl Biotec) in 3 cycles of either 3 or 4 consecutive IA's over an 8-week period. Mean FEV1 was 75.1 ± 36% predicted before IA. IgE ranged between 1400 – 35000 kU/L.

45 IA treatments were successfully completed. 4 treatments were abandoned due to difficulty in siting peripheral cannulae. 1 treatment was not attempted due to patient fatigue. Mean FEV1 after IA was 74.9 ± 35.3% and was stable at 3 months. Each cycle of IA reduced IgE by around 80%. IA was not associated with any trend to improved PEFRs and there was no clinically significant improvement in ACT or ACQ7 scores. Complement markers and CRP were not raised after IA. Satisfaction scores indicated IA was tolerated.

IgE Immunoadsorption provides a safe and acceptable form of targeting raised IgE in patients with Asthma and ABPA. Further studies may be needed to demonstrate if this treatment is clinically effective.

2016

abstract No: 

OA4835

Full conference title: 

European Respiratory Society 2016
    • ERS 26th (2016)