CASE REPORT article
Front. Pharmacol.
Sec. Respiratory Pharmacology
Volume 16 - 2025 | doi: 10.3389/fphar.2025.1588182
Omalizumab Combined with Voriconazole for the Treatment of ABPA Complicating IPA: A Case Report
Provisionally accepted
- 1Department of Clinical Pharmacy, The Third Hospital of Mianyang, Sichuan Mental Health Center, mianyang, China
- 2Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, Shanghai Municipality, China
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Aspergillus invading hosts may manifest as Allergic bronchopulmonary aspergillosis (ABPA) or invasive pulmonary aspergillosis (IPA) in individuals with varying immune statuses. ABPA predominantly occurs in severe asthma patients, whereas IPA is typically observed in immunocompromised individuals. ABPA management centers on glucocorticoids to mitigate hypersensitivity-driven inflammation, while IPA requires aggressive antifungal therapy. Concurrent ABPA and IPA presents a therapeutic dilemma, as glucocorticoids use may exacerbate fungal dissemination, while antifungal agents alone inadequately address the allergic component. Adjusting treatment strategies to balance immunosuppression to control ABPA with sufficient antifungal coverage for IPA is critical step. The case report presents an innovative therapeutic strategy for a 73-year-old female with co-existing ABPA and IPA. After suboptimal clinical response to conventional glucocorticoid-antifungal therapy, we implemented a guideline-aligned, evidence-based regimen combining omalizumab with voriconazole. While this dual therapy achieved clinical stabilization, persistently elevated serum IgE (>5000 IU/mL). By reviewing the literature and comparing the differences between the mechanisms of omalizumab and dupilumab, the treatment was finally changed from omalizumab to dupilumab and followed up. This case is also a practice guided by ISHAM guidelines while pioneering a mechanism-driven transition from omalizumab to dupilumab in ABPA-IPA co-management. In order to provide guidance for the treatment of ABPA-IPA disease.
Keywords: Allergic bronchopulmonary aspergillosis, Glucocorticoids, Omalizumab, Dupilumab, Voriconazole ABPA, Aspergillus
Received: 14 Mar 2025; Accepted: 11 Jun 2025.
Copyright: © 2025 Zhao, Chen and SUN. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: He SUN, Department of Respiratory and Critical Care Medicine, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, Shanghai Municipality, China
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