Biologics suppresses asthma exacerbation in patients with allergic bronchopulmonary mycosis (ABPM)

<bold>Introduction:</bold> The mainstay of treatment in patients with ABPM is systemic corticosteroids and antifungal agents. However, some patients have repeated asthma exacerbations and develop decreased lung function. <bold>Aims:</bold> To evaluate the effect of biologics on asthma exacerbations and lung function after ABPM diagnosis. <bold>Methods:</bold> We retrospectively analyzed 29 ABPM patients treated at the NHO Yokohama Medical Center between April 2022 and January 2024. We diagnosed ABPM according to the new Japanese criteria (Asano et al., JACI 2021;147:1261). Twelve patients were treated with biologics. We investigated lung function (FVC, and FEV1) and asthma exacerbation rates at diagnosis and during conventional therapy in the non-biologics group (NBG) and the biologics group (BG), as well as during biologics treatment in the BG. <bold>Results:</bold> Mean period of time from ABPM diagnosis to biologics administration was 4.3 ± 5.3 years and mean duration of biologics therapy was 2.3 ± 3.3 years. The %FVC at diagnosis were significantly lower in the BG than in the NBG (P < 0.01), but the eosinophil count and serum IgE level at diagnosis did not differ significantly between groups. Asthma exacerbation rates before biologics administration were significantly higher in the BG than in the NBG (P < 0.01), but in the BG they were significantly lower after biologics treated than before (P < 0.01). High serum IgE levels reflected decreases in FVC (P < 0.05) in all ABPM patients, but %FVC, and %FEV1 tended to increase after biologics treatment. <bold>Conclusion:</bold> Our results suggest that biological therapy may suppress both asthma exacerbation rates and declining lung function over time in ABPM.