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
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research

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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.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Allergy and immunology Source Type: research
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...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Allergy and immunology Source Type: research
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.
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Allergy and immunology Source Type: research
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...
Source: European Respiratory Journal - Category: Respiratory Medicine Authors: Tags: Allergy and immunology Source Type: research
Conclusions. The applied diagnostic criteria had no significant effect on the reported rate of ABPA prevalence. PMID: 31702121 [PubMed - as supplied by publisher]
Source: European Annals of Allergy and Clinical Immunology - Category: Allergy & Immunology Tags: Eur Ann Allergy Clin Immunol Source Type: research
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.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Source Type: research
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.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Source Type: research
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.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Source Type: research
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.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Source Type: research
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.
Source: The Journal of Allergy and Clinical Immunology: In Practice - Category: Allergy & Immunology Source Type: research
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