TY - JOUR T1 - Omalizumab and voriconazole in allergic broncopulmonary aspergillosis (A case series) JF - European Respiratory Journal JO - Eur Respir J VL - 38 IS - Suppl 55 SP - p276 AU - Anna Stanziola AU - Emanuela Carpentieri AU - Carolina Vitale AU - Manuela Pitassi AU - Nunzia Sorrentino AU - Matteo Sofia Y1 - 2011/09/01 UR - http://erj.ersjournals.com/content/38/Suppl_55/p276.abstract N2 - Allergic bronchopulmonary aspergillosis (ABPA) in immunocompetent patients may represent a cause of severe, difficult to control asthma associated with recurrent exacerbations and dependence to systemic steroid.We describe of 5 F patients, age mean 62.6 y (range 50 - 74) with ABPA who were treated with combined anti-IgE omalizumab and Voriconazole.They have skin prick test positive to different pollens (Parietaria, grass) and perennial allergens such as mites and Aspergillus fumigatus, but also high levels of total (732±228 UI/mL) and specific IgE towards Aspergillus f. (>25 Ku/L) in the absence of invasive aspergillosis. Their treatment consisted of ICS and LABA daily and orally steroids during exacerbations (about 6-7/y).All of the patients have CT- rhinosinusitis and 1of 5 pts has radiological signs of bronchiectasis. The PFR showed obstructive ventilatory pattern with FEV1% th = 66±6; FVC% th = 77±11 and ACT score was 17.Voriconazole 200mg bid was admistrated for two months before treatment with biological therapy with Omalizumab even if the serum levels of galactomannan were negative. 3 months later treatment with voriconazole, the specific Aspergillus f. IgE levels returned normal.After 1 year of treatment with Omalizumab, the exacerbations rate (8 vs 3) and the ACT score were reduced (21 vs 17); FEV1% th 75 improved and total IgE levels were lower (363±173 UI/mL). Second year of treatment: the specific aspergillus IgE levels returned to be high but no exacerbation was registred and ACT remained stable.In APBA patients with severe allergic asthma the combined therapy with omalizumab and voriconazole in burst might offer a longer and safer approach in this setting. ER -