Dupilumab treatment for Allergic Bronchopulmonary Aspergillosis: A case series
Publication date: Available online 4 December 2019Source: The Journal of Allergy and Clinical Immunology: In PracticeAuthor(s): Richard Ramonell, Frances Eun-Hyung Lee, Colin Swenson, Merin Kuruvilla
Conclusion: ABPA patients have higher levels of sIgG and sIgE of A.fumigatus than SAFS patients. Combination of sIgG and sIgE of A.fumigatus to diagnosis ABPA and SAFS patients is important.
Aspergillus (ASP) sensitization is frequent in severe asthma (SA). Aspergillus-associated disease, such as allergic bronchopulmonary aspergillosis (ABPA) and chronic pulmonary aspergillosis (CPA) can be associated with bronchiectasis (B). B is a comorbidity in patients with SA. We investigated the prevalence and the characteristics of Aspergillus-associated bronchiectasis in 73 consecutive immunocompetent patients with SA.Methods: All the patients underwent assessment of history, spirometry, FENO, circulating eosinophils (EOS), serum total IgE, IgE-ASP (increased if> 0.10 kUA/L), and IgG-ASP (increased if>40 U/ml), c...
Conclusions: The severe asthmatic patients examined had a high prevalence of Aspergillus sensitization and of Aspergillus-associated diseases as ABPA (26%) and CPA (26%). It has to be demonstrated the benefit of an early recognition and treatment of these diseases on the course of asthma.
Three years ago we started treating patients diagnosed with ABPA, an allergic lung disease provoked by Aspergillus fumigatus (Af), with a combined therapy of voriconazole and prednisolone. We used voriconazole at a dose of 200 mg twice a day for 4 months, while the initial prednisolone dose was 0.75 mg/kg/day for 1 month, then 0.25 mg/kg/day for 1 month, then progressive tapering (5 mg each fortnight) until the minimum dose of 5 mg/day, maintained until the fourth month. We evaluated patients at 6 months from the end of therapy. We enrolled 25 patients in the disease acute phase, who had never used azol therapy before, wit...
Conclusions. The applied diagnostic criteria had no significant effect on the reported rate of ABPA prevalence. PMID: 31702121 [PubMed - as supplied by publisher]
We describe a case of a 32-month-old male with CGD who presented acutely with decreased energy and non-specific abdominal discomfort. Upon further work up he was found to have invasive Aspergillus fumigatus.
Dupilumab, a fully human monoclonal antibody, blocks the shared receptor component for IL-4/IL-13, key drivers of type 2 inflammation in multiple diseases. In the phase 3 LIBERTY ASTHMA QUEST study (NCT02414854), add-on dupilumab 200mg/300mg every 2 weeks vs placebo reduced severe exacerbations and improved pre-bronchodilator FEV1 in patients with uncontrolled, moderate-to-severe asthma. Treatment effects were greater in patients with elevated baseline type 2 biomarkers. Allergic bronchopulmonary aspergillosis (ABPA) is characterized by Aspergillus fumigatus (Af) hypersensitivity and robust type 2 inflammatory responses.
Allergic bronchopulmonary aspergillosis (ABPA) affects up to 15% of patients with cystic fibrosis (CF), representing a significant clinical challenge. It is especially a concern in the pediatric population given adverse effects of steroids in this population. Here we report on the use of omalizumab in the treatment of steroid-resistant ABPA in a pediatric patient with CF.
Allergic bronchopulmonary aspergillosis (ABPA) has varying degrees of disease activity, one of which is a refractory form with an inability to taper off systemic steroids. Additionally, azoles, through CYP3A4 inhibition, can increase concentrations of steroids and increase the risk of adverse effects.
ConclusionsIgE against rAsp f1 and f2 (using receiver-operating characteristic–derived cutoffs) were found to be the most useful in differentiating ABPA from ASA. Because this study was conducted at a single center, our results require further validation.