Mepolizumab improved airway hyperresponsiveness in a patient with allergic bronchopulmonary aspergillosis

Chisato Onitsuka,¹ Tetsuya Homma,¹ Tomoko Kawahara,¹ Tomoyuki Kimura,¹ Yoshito Miyata,¹ Hironori Sagara¹

¹ Showa University School of Medicine, Department of Medicine, Division of Respiratory Medicine and Allergology, Tokyo, Japan

Abstract

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a severe type of asthma characterized by hypersensitivity to Aspergillus fumigatus and lung infiltration with eosinophilia. The central pathogenesis of asthma is airway hyperresponsiveness (AHR), with eosinophils playing a critical role. Anti-interleukin (IL)-5 antibody therapy has been recently introduced to treat severe asthma, which reportedly inactivates and reduces eosinophil count. A recent case series highlighted the improvement in asthmatic symptoms associated with ABPA, but previous reports failed to demonstrate any improvement in AHR.
Objective: Herein, we aimed to elucidate the efficacy of mepolizumab in a patient with ABPA who showed improvement in AHR.
Method: Case report.
Results: A 63-year-old Asian woman with ABPA showed improvement in asthmatic symptoms and AHR following mepolizumab therapy.
Conclusion: Our results suggest that IL-5 may serve in the pathogenesis of ABPA
Key words: Aspergillus fumigatus, ABPA, severe asthma, AHR, mepolizumab