Combination anti-IgE and anti-IL5 therapies in patients with severe persistent asthma and allergic bronchopulmonary aspergillosis (ABPA).
Monday, March 5, 2018
South Hall A2 (Convention Center)
Jay Patel, MD, Andrew G. Ayars, MD FAAAAI, Lahari Rampur, MD, Stephen Bronson, RN, Matthew C. Altman, MD

Many patients with severe persistent asthma have evidence of both Th2 and eosinophilic inflammation. This is often seen in ABPA with IgE levels >1000 U/mL and peripheral eosinophil counts >500 cells/mL, however, can also be seen without aspergillus sensitization. The optimal approach to steroid-sparing biologic therapy in such patients is unclear, and many continue to have active disease after a single biologic therapy is initiated.


We performed a retrospective review of severe asthma patients treated with both anti-IgE and anti-IL5 therapies at the University of Washington (UW). Provider visits, spirometry and labs were performed at UW Medical Center.


We identified 4 patients treated with combination anti-IgE and anti-IL5 therapies simultaneously after failing single monoclonal therapy. Three met diagnostic criteria for ABPA. The average pre-treatment IgE was 997 U/mL, (range 134-1730), eosinophil count 725 cells/mL (range 360-1080), and FEV1 52% (range 26-72% predicted). All patients were initially treated with omalizumab and had a partial response defined as decrease in systemic corticosteroids and improvement in pulmonary function or symptoms; however, none could completely discontinue systemic corticosteroids. Sequential addition of anti-IL5 therapy allowed cessation of systemic corticosteroids in all patients. There have been no adverse events related to dual therapy.


Combination anti-IgE and anti-IL5 therapy should be considered in patients with severe persistent asthma or ABPA who continue to require systemic steroids or have frequent exacerbations despite single biologic therapy. Blocking Th2 and eosinophilic inflammation may be synergistic resulting in significant clinical improvement in these patients.