Omalizumab Treatment in Patients with Cystic Fibrosis (CF) and Allergic Bronchopulmonary Aspergillosis (ABPA): a Case Series

Author address: 

Johana B. Castro-Wagner, MD, Chen Hsing Lin, MD, Farnaz Tabatabaian, MD, Nathan Tang, MD FAAAAI, Panida Sriaroon, MD FAAAAI

Abstract: 

Rationale: ABPA occurs predominantly in individuals with asthma or CF. Standard treatment for ABPA includes oral corticosteroids and, occasionally, antifungal agents. It has been reported that omalizumab, a monoclonal anti-IgE antibody, can be an effective treatment for CF patients with ABPA. 

Methods: We performed a retrospective chart review on three adolescent CF patients who were diagnosed with ABPA and treated with omalizumab.

Patients 1 and 2 presented with pulmonary exacerbations, diminishing FEV1, and abnormal chest radiographs. Pseudomonas aeruginosa and Aspergillus fumigatus were detected in bronchoalveolar lavage fluid from patient 1, and Mycobacterium spp. and A. fumigatus from patient 2. Patient 3 was previously diagnosed with ABPA at age 8 and received a trial of omalizumab treatment after unsatisfactory response to standard therapy. Symptoms improved and omalizumab was maintained for 3 years. Three years later, his lung function deteriorated. New infiltrates were noted on chest radiograph, and sputum cultures showed A. fumigatus.

Results: Additional investigation revealed skin test positivity to A. fumigatus and presence of A. fumigatus specific IgE and IgG in all 3 patients, suggesting ABPA diagnosis. Corticosteroids were withheld due to concomitant bacterial infection in patients 1 and 2, and history of corticosteroid-induced hypertension in patient 3. Treatment with omalizumab injection every 2 weeks was initiated and led to a substantial clinical improvement. After 3 months of therapy, FEV1 increased from baseline in all 3 patients.  

Conclusions: Omalizumab may be an effective, alternative therapy for ABPA in CF patients who fail to respond to systemic corticosteroids or have contraindications to its use.

2017

abstract No: 

92

Full conference title: 

The American Academy of Allergy, Asthma & Immunology 2017
    • AAAAI 2017 (73rd)