Omalizumab in allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Moshe Ashkenazi,1,2 Saray Sity,2 Ifat Sarouk,1,2 Bat El Bar Aluma,1,2 Adi Dagan,1,2 Yael Bezalel,1,2 Lea Bentur3 Kris De Boeck,4 Ori Efrati1,2 1Pediatric Pulmonology and National CF Center, Edmond and Lilly Safra Children’s Hospital, Sheba Medical Center, Ramat Gan, Israel; 2Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; 3Pediatric Pulmonology Institute, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel; 4Pediatric Pulmonology, Department of Pediatrics, University of Leuven, Leuven, Belgium Background: Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterized by a Th2 response, serum eosinophilia, and increased total serum IgE to Aspergillus fumigatus. ABPA occurs in cystic fibrosis (CF) and asthma. Omalizumab is a humanized recombinant monoclonal antibody against IgE. Previous studies reported borderline results when treating ABPA with omalizumab. Methods: A retrospective study to investigate the efficacy of omalizumab in the treatment of ABPA in CF patients was conducted at 3 CF centers in Israel and Belgium. Data were obtained from the digital archive. We measured 4 outcome parameters: forced expiratory volume in 1 second, body mass index, pulmonary exacerbations, and steroid sparing. Results: The database was composed on the records of 9 patients. None of the outcome parameters showed any improvement. A favorable outcome was observed in patients with higher levels of posttreatment total IgE than those with lower levels. CF-related diabetes and male gender showed trends for poorer outcomes. Conclusion: No benefits were detected on treating ABPA in CF with omlaizumb. Monitoring the total IgE was not helpful. A prospective randomized double-blind study is needed. Keywords: ABPA, Omalizumab, CF, IgE