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
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.
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
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%.
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.
Full conference title:
- ERS 26th (2016)