title: Anti IgE antibody as treatment of allergic bronchopulmonary aspergillosis in a patient with cystic fibrosis.
abstract: Allergic bronchopulmonary aspergillosis (ABPA) occurs in 7-9% of patients with cystic fibrosis (CF) and causes a worsening of lung function and respiratory symptoms. Standard treatment of ABPA consists of oral steroids; however, higher corticosteroid therapy associated to antifungal agent (itraconazole) long-term treatments are often required to reduce respiratory exacerbations and to prevent progressive lung damage. Here we describe the case of a girl with CF who experienced clinical and functional improvement over 12-months treatment with omalizumab. At birth, our patient was diagnosed with mild-to-moderate CF and from childhood she underwent annual cycles of antibiotic and corticosteroid therapies. At 12 years, she presented with a worsening respiratory condition, asthma symptoms and reduced lung function (FEV1 of 78%). Blood tests showed an increased concentration of plasma total IgE and positive specific IgE antibodies to Aspergillus fumigatus; allergic skin tests were also positive for A. fumigatus. The patient started steroid therapy but had impaired glucose tolerance due to long-term steroid use. Subcutaneous omalizumab 300 mg every two weeks was initiated and after 14 weeks she had improved respiratory symptoms (FEV1 99%) and a marked reduction in the use of systemic antibiotic and corticosteroid therapies. No side effects were reported. Our case shows that therapy with omalizumab for a prolonged period can resolve symptoms of asthma.
authors.affiliation: Department of Pediatrics, Sapienza University of Rome, Rome, Italy. marzia.duse@gmail.com.
authors.forename: A M
authors.initials: AM
authors.lastname: Zicari
authors.forename: C
authors.initials: C
authors.lastname: Celani
authors.forename: G
authors.initials: G
authors.lastname: De Castro
authors.forename: R
authors.initials: R
authors.lastname: Valerio De Biase
authors.forename: M
authors.initials: M
authors.lastname: Duse
mesh_terms: D000293:Adolescent; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D000888:Antibodies, Anti-Idiotypic / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D001232:Aspergillus fumigatus / Q000276:immunology; D001249:Asthma / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D003550:Cystic Fibrosis / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology*; D000069444:Omalizumab
chemical_list: D018926:Anti-Allergic Agents; D000888:Antibodies, Anti-Idiotypic; D061067:Antibodies, Monoclonal, Humanized; D000069444:Omalizumab; D007073:Immunoglobulin E