Management of patients with cystic fibrosis and allergic bronchopulmonary aspergillosis using anti-immunoglobulin e therapy (omalizumab)

Abstract

Omalizumab is a recombinant DNA-derived humanized immunoglobulin G (IgG) anti-IgE monoclonal antibody approved for use in patients with allergic asthma. However, it is not approved for allergic bronchopulmonary aspergillosis (ABPA). Conflicting reports exist about the effects of omalizumab on ABPA in patients with cystic fibrosis (CF). We report 2 patients with CF treated with omalizumab, in whom frequency of ABPA exacerbations was markedly reduced with treatment. Additionally, hospitalizations were reduced from 5 per year to once in 18 months in the first patient and from twice to once per year in the second patient. Free IgE decreased by 87.9% after 6 months of therapy in the first patient and by 95.6% after 7 months of therapy in the second patient. Neither of the two patients had evidence of asthma. Omalizumab may be useful in treating ABPA in patients with CF, and including free IgE in monitoring the response to therapy will be helpful.

Keywords: Allergic bronchopulmonary aspergillosis; cystic fibrosis; free IgE; omalizumab.

Figure 1.

FEV₁ (solid diamonds with solid line), FVC (solid circles with solid line), hospitalizations (solid triangles), and omalizumab injections (solid squares) over time for Case 1. FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity

Figure 2.

Free (dashed line) and total IgE (solid line) concentrations for Case 1.

Figure 3.

FEV₁ (dashed line), FVC (solid line), hospitalizations (solid triangles), and omalizumab injections (solid squares) over time for Case 2. FEV₁, forced expiratory volume in 1 second; FVC, forced vital capacity.