Allergic bronchopulmonary aspergillosis (ABPA) is a complex respiratory disease with significant morbidity and mortality. ABPA occurs in 10% of patients with severe asthma. Patients usually demonstrate positive skin prick test to Aspergillus, decline in lung function, elevated total IgE levels, elevated Aspergillus fumigatus specific IgE antibody, and central bronchiectasis. Symptoms are often persistent despite conventional asthma therapy. Serious adverse effects from long-term use of high dose inhaled and oral corticosteroids include immunosuppression, adrenal insufficiency, osteoporosis, and many others. Antifungals are also problematic due to drug interactions and monitoring requirements. Some studies suggest that omalizumab may be a better therapeutic option as there is some evidence demonstrating efficacy in ABPA and fewer adverse effects than long-term corticosteroids.
A retrospective chart review was performed on ABPA patients receiving omalizumab from 2007-2015 at our tertiary care Allergy & Asthma Clinic and The Ottawa Hospital Chest Clinic. Data was collected on demographics, skin prick testing, inhaled /oral corticosteroid use, asthma exacerbations/hospitalizations and quality of life (QoL).
Ten patients were evaluated (59.7±13.9 years, 7 females, 3 males). By month 16, the average dose of inhaled corticosteroids dropped by 24%.There was an 89% drop in prednisone intake from baseline in three oral-steroid dependent patients. Nine subjects reported exacerbations 12 months prior to treatment, but none reported exacerbations once they started omalizumab. QoL scores improved from baseline.
Our retrospective study provides compelling evidence that supports the hypothesis that omalizumab may be an effective low-risk treatment for ABPA patients, a much underserved patient population.