Omalizumab and voriconazole in allergic broncopulmonary aspergillosis (A case series

Ref ID: 18400

Author:

Anna Stanziola, Emanuela Carpentieri, Carolina Vitale, Manuela Pitassi,
Nunzia Sorrentino, Matteo Sofia.

Author address:

Department of Lung Diseases, University
Federico II Naples, Naples, Italy

Full conference title:

European Respiratory Congress

Abstract:

Allergic bronchopulmonary aspergillosis (ABPA) in immunocompetent patients
may represent a cause of severe, difficult to control asthma associated with recurrent
exacerbations and dependence to systemic steroid.We describe of 5 F patients,
age mean 62.6 y (range 50 – 74) with ABPA who were treated with combined anti-
IgE omalizumab and Voriconazole.They have skin prick test positive to different
pollens (Parietaria, grass) and perennial allergens such as mites and Aspergillus
fumigatus, but also high levels of total (732±228 UI/mL) and specific IgE towards
Aspergillus f. (>25 Ku/L) in the absence of invasive aspergillosis. Their treatment
consisted of ICS and LABA daily and orally steroids during exacerbations (about
6-7/y).
All of the patients have CT- rhinosinusitis and 1of 5 pts has radiological signs
of bronchiectasis. The PFR showed obstructive ventilatory pattern with FEV1%
th = 66±6; FVC% th = 77±11 and ACT score was 17.Voriconazole 200mg bid
was admistrated for two months before treatment with biological therapy with
Omalizumab even if the serum levels of galactomannan were negative. 3 months
later treatment with voriconazole, the specific Aspergillus f. IgE levels returned
normal.
After 1 year of treatment with Omalizumab, the exacerbations rate (8 vs 3) and the
ACT score were reduced (21 vs 17); FEV1% th 75 improved and total IgE levels
were lower (363±173 UI/mL). Second year of treatment: the specific aspergillus
IgE levels returned to be high but no exacerbation was registred and ACT remained
stable.In APBA patients with severe allergic asthma the combined therapy with
omalizumab and voriconazole in burst might offer a longer and safer approach in
this setting.

Abstract Number: P276

Conference Year: 2011

Link to conference website: http://www.ers-education.org/ersMade/abstract_print_11/files/Abstract_book_2011.pdf

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