One population we know is particularly vulnerable to ABPA is those people with cystic fibrosis (CF). Figures vary but something like 10 - 25% of people with CF get ABPA. Perhaps that is not surprising as their lungs are prone to infections as they cannot properly rid themselves of infectious particles including mould spores. Someone with CF already has severe problems breathing without suffering from contributing infections and some figures suggest 50% of all people living with CF have some form of infection by Aspergillus - not all are thought to progress to ABPA.
Treatment for ABPA is to use steroids to control inflammation and often an antifungal drug which can allow the dose of the steroid medication to be minimised, thus helping to avoid some of the many unpleasant side effects of taking high dose corticosteroids. This doesn't work for everyone and alternatives are being actively sought.
Originally developed for severe asthmatics, Omalizumab (Xolair) directly targets the parts of our immune system that leads to excessive inflammation. In asthmatics this has been demonstrated to lessen symptoms and has benefited patients. Many CF patients and those with ABPA are also asthmatic. ABPA is known to cause chronic airway inflammation and so ABPA patients are a candidate for use of this drug.
Some of the toughest patients to treat are probably those with CF and ABPA and we now have the first reports of patients from those groups who are being treated with Omalizumab. The most recent paper by Lehman et. al. looks at a small number of patients (6) with wide age range (age 4 - 33) treated over 7 years and suggested that Omalizumab was beneficial especially in those who had less progressed disease with benefits of taking lass corticosteroid also apparent.
This result offers hope for alternative treatment to ABPA patients who do not have CF,