Steroid sparing effect of omalizumab in seropositive allergic bronchopulmonary aspergillosis

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a common serious hypersensitivity reaction to airway colonization with Aspergillus in patients with asthma or cystic fibrosis. While steroids are effective in controlling the respiratory symptoms of ABPA, they have many side effects that make them undesirable for long term use. Antifungals have been used to reduce dependency on systemic steroids but long term use can be limited by side effects and there is the possibility of developing resistance to azoles. Some clinicians have successfully used anti- immunoglobulin E (anti-IgE) therapy in various populations, though it is frequently added to antifungals. Objective: Further describe the utility of anti-IgE therapy for ABPA for patients unable to tolerate antifungals. Methods: We describe the case of a patient with serologic ABPA who did not tolerate therapy with antifungals but was able to significantly reduce her average daily steroid use while receiving anti-IgE therapy with omalizumab added to her other respiratory medications. Results: After therapy with omalizumab, our patient was able to reduce her need for daily corticosteroids by nearly 80%. Conclusions: Omalizumab may reduce corticosteroid dependence in patients with allergic bronchopulmonary aspergillosis for patients unable to tolerate antifungals, though use may be limited by cost. Additional studies are needed.