Abstract
Background: Allergic bronchopulmonary aspergillosis (ABPA) develops in the presence of predisposing conditions such as asthma and cystic fibrosis. Even ABPA accompanied by asthma is often complicated by chronic Pseudomonas aeruginosa or nontuberculous mycobacterial infection of the lower respiratory tract, rendering treatment with corticosteroids difficult. There have been several reports on the effectiveness of omalizumab, an anti-IgE antibody, in patients with ABPA. We analyzed the effectiveness and adverse effects of omalizumab in ABPA patients with chronic respiratory infections. Methods: Using our nationwide survey database and published case reports, we identified patients with severe asthma and ABPA who fulfilled the International Society for Human and Animal Mycology criteria and who had been treated with omalizumab. Exacerbation rates, control of symptoms, doses of oral corticosteroids, and pulmonary function were evaluated. Results: Among 25 patients with ABPA treated with omalizumab (median age 62 years, range 33–83 years), 12 patients had a chronic bacterial infection of the lower airways attributable to P. aeruginosa (n = 6) or nontuberculous mycobacteria (n = 6) at the initiation of omaliz-umab. Treatment with omalizumab reduced the frequency of exacerbations and systemic corticosteroid doses and improved pulmonary function. There were no significant adverse events or worsening of infection during treatment with omalizumab, except for injection-site reactions. Conclusions: Treatment with omalizumab was effective and safe in patients with ABPA, regardless of comorbid chronic respiratory tract infections.
References
1.
Agarwal
R
, Chakrabarti
A
, Shah
A
, Gupta
D
, Meis
JF
, Guleria
R
, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria
. Clin Exp Allergy
. 2013 Aug
;43
(8
):850
–73
. 2.
Asano
K
, Kamei
K
, Hebisawa
A
. Allergic bronchopulmonary mycosis: pathophysiology, histology, diagnosis, and treatment
. Asia Pac Allergy
. 2018 Jul
;8
(3
):e24
. 3.
Denning
DW
, Pleuvry
A
, Cole
DC
. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults
. Med Mycol
. 2013 May
;51
(4
):361
–70
. 4.
Patterson
R
, Greenberger
PA
, Halwig
JM
, Liotta
JL
, Roberts
M
. Allergic bronchopulmonary aspergillosis. Natural history and classification of early disease by serologic and roentgenographic studies
. Arch Intern Med
. 1986 May
;146
(5
):916
–8
. 5.
Agarwal
R
, Gupta
D
, Aggarwal
AN
, Behera
D
, Jindal
SK
. Allergic bronchopulmonary aspergillosis: lessons from 126 patients attending a chest clinic in North India
. Chest
. 2006 Aug
;130
(2
):442
–8
. 6.
Oguma
T
, Taniguchi
M
, Shimoda
T
, Kamei
K
, Matsuse
H
, Hebisawa
A
, et al. Allergic bronchopulmonary aspergillosis in Japan: a nationwide survey
. Allergol Int
. 2018 Jan
;67
(1
):79
–84
. 7.
Curtis
JR
, Westfall
AO
, Allison
J
, Bijlsma
JW
, Freeman
A
, George
V
, et al. Population-based assessment of adverse events associated with long-term glucocorticoid use
. Arthritis Rheum
. 2006 Jun 15
;55
(3
):420
–6
. 8.
Geller
DE
, Kaplowitz
H
, Light
MJ
, Colin
AA
. Allergic bronchopulmonary aspergillosis in cystic fibrosis: reported prevalence, regional distribution, and patient characteristics. Scientific Advisory Group, Investigators, and Coordinators of the Epidemiologic Study of Cystic Fibrosis
. Chest
. 1999 Sep
;116
(3
):639
–46
. 9.
Ionescu
MD
, Balgradean
M
, Marcu
V
. Allergic bronchopulmonary aspergillosis in patient with cystic fibrosis: a case report
. Maedica
. 2014 Dec
;9
(4
):387
–90
.10.
Reece
E
, Segurado
R
, Jackson
A
, McClean
S
, Renwick
J
, Greally
P
. Co-colonisation with Aspergillus fumigatus and Pseudomonas aeruginosa is associated with poorer health in cystic fibrosis patients: an Irish registry analysis
. BMC Pulm Med
. 2017 Apr 21
;17
(1
):70
. 11.
Ishiguro
T
, Takayanagi
N
, Takaku
Y
, Kagiyama
N
, Shimizu
Y
, Yanagisawa
T
, et al. Allergic bronchopulmonary aspergillosis with repeated isolation of nontuberculous mycobacteria
. Intern Med
. 2013
;52
(15
):1721
–6
. 12.
Ishiguro
T
, Takayanagi
N
, Baba
Y
, Takaku
Y
, Kagiyama
N
, Sugita
Y
. Pulmonary nontuberculous mycobacteriosis and chronic lower respiratory tract infections in patients with allergic bronchopulmonary mycosis without cystic fibrosis
. Intern Med
. 2016
;55
(9
):1067
–70
. 13.
Tsubouchi
H
, Tsuchida
S
, Yanagi
S
, Shigekusa
T
, Miura
M
, Sakaguchi
K
, et al. Successful treatment with mepolizumab in a case of allergic bronchopulmonary aspergillosis complicated with nontuberculous mycobacterial infection
. Respir Med Case Rep
. 2019
;28
:100875
. 14.
Presta
LG
, Lahr
SJ
, Shields
RL
, Porter
JP
, Gorman
CM
, Fendly
BM
, et al. Humanization of an antibody directed against IgE
. J Immunol
. 1993 Sep 1
;151
(5
):2623
–32
.15.
Humbert
M
, Beasley
R
, Ayres
J
, Slavin
R
, Hebert
J
, Bousquet
J
, et al. Benefits of omalizumab as add-on therapy in patients with severe persistent asthma who are inadequately controlled despite best available therapy (GINA 2002 step 4 treatment): innovate
. Allergy
. 2005 Mar
;60
(3
):309
–16
. 16.
Hanania
NA
, Alpan
O
, Hamilos
DL
, Condemi
JJ
, Reyes-Rivera
I
, Zhu
J
, et al. Omalizumab in severe allergic asthma inadequately controlled with standard therapy: a randomized trial
. Ann Intern Med
. 2011 May 3
;154
(9
):573
–82
. 17.
Perez-de-Llano
LA
, Vennera
MC
, Parra
A
, Guallar
J
, Marin
M
, Asensio
O
, et al. Effects of omalizumab in Aspergillus-associated airway disease
. Thorax
. 2011 Jun
;66
(6
):539
–40
. 18.
Homma
T
, Kurokawa
M
, Matsukura
S
, Yamaguchi
M
, Adachi
M
. Anti-IgE therapy for allergic bronchopulmonary aspergillosis
. J Microbiol Immunol Infect
. 2016 Jun
;49
(3
):459
–63
. 19.
Voskamp
AL
, Gillman
A
, Symons
K
, Sandrini
A
, Rolland
JM
, O’Hehir
RE
, et al. Clinical efficacy and immunologic effects of omalizumab in allergic bronchopulmonary aspergillosis
. J Allergy Clin Immunol Pract
. 2015 Mar–Apr
;3
(2
):192
–9
. 20.
Hochhaus
G
, Brookman
L
, Fox
H
, Johnson
C
, Matthews
J
, Ren
S
, et al. Pharmacodynamics of omalizumab: implications for optimised dosing strategies and clinical efficacy in the treatment of allergic asthma
. Curr Med Res Opin
. 2003
;19
(6
):491
–8
. 21.
Chakrabarti
A
, Sethi
S
, Raman
DS
, Behera
D
. Eight-year study of allergic bronchopulmonary aspergillosis in an Indian teaching hospital
. Mycoses
. 2002 Oct
;45
(8
):295
–9
. 22.
Kim
JH
, Jin
HJ
, Nam
YH
, Hwang
EK
, Ye
YM
, Park
HS
. Clinical features of allergic bronchopulmonary aspergillosis in Korea
. Allergy Asthma Immunol Res
. 2012 Sep
;4
(5
):305
–8
. 23.
Mussaffi
H
, Rivlin
J
, Shalit
I
, Ephros
M
, Blau
H
. Nontuberculous mycobacteria in cystic fibrosis associated with allergic bronchopulmonary aspergillosis and steroid therapy
. Eur Respir J
. 2005 Feb
;25
(2
):324
–8
. 24.
Kadamkulam Syriac
A
, Malhotra
G
, Anez de Gomez
CI
, Copur
AS
. Mycobacterium avium intracellulare infection complicated by allergic bronchopulmonary aspergillosis in a non-asthmatic patient
. BMJ Case Rep
. 2018 May 26
;2018
:bcr2018224835
.25.
Jat
KR
, Walia
DK
, Khairwa
A
. Anti-IgE therapy for allergic bronchopulmonary aspergillosis in people with cystic fibrosis
. Cochrane Database Syst Rev
. 2018 Mar 18
;3
:CD010288
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2020
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