📘 Managing IgE Levels in ABPA: What Happens After Treatment?

If you have ABPA (Allergic Bronchopulmonary Aspergillosis), you’ve likely been told your IgE levels are high. Many patients ask:

“Once my IgE goes down with treatment, how do I keep it down without staying on steroids or antifungals forever?”

This guide explains why IgE is important, how it’s treated, and what long-term steps you can take to stay well.

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🧪 What is IgE and Why Is It High in ABPA?

IgE (Immunoglobulin E) is an antibody your immune system makes in response to allergens. In ABPA, your immune system overreacts to Aspergillus, a common fungus, causing inflammation in the lungs. This leads to:

• High total IgE levels (often over 1,000–10,000 IU/mL)

• Symptoms like coughing, wheezing, and mucus plugs

• Lung changes on scans, if untreated

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🎯 Treatment Goals

Treatment aims to:

• Lower inflammation

• Reduce the fungal burden

• Bring IgE levels down (a marker that your inflammation is settling)

• Prevent long-term lung damage

You might be treated with:

• Oral steroids (e.g. prednisolone)

• Antifungal tablets (e.g. itraconazole or voriconazole)

These medications help bring IgE levels down, sometimes dramatically. But they can’t usually be taken forever — long-term use may cause side effects.

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🔄 After IgE Drops – What Next?

Even after successful treatment, ABPA can flare up again. So the key questions become:

How do we keep IgE low?
How do we prevent future flare-ups?

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🧭 Long-Term Management Options

1. Close Monitoring

• IgE is checked every 2–6 months

• Doctors look for a doubling in IgE — this can mean a flare is starting

• Regular chest scans and lung function tests are also used to spot changes early

2. Tapering Medication

• Steroids are slowly reduced, not stopped suddenly

• Your doctor will watch for any return of symptoms or rise in IgE

3. Biologic Treatments

Some newer medications can help long-term, especially if you:

• Have frequent flare-ups

• Can’t reduce steroids safely

• Have asthma or eosinophilic inflammation

These include:

• Omalizumab (anti-IgE antibody)

• Mepolizumab / Benralizumab (target eosinophils)

• Dupilumab (blocks part of the allergy pathway)

Biologics are usually injections given every 2–4 weeks, and can help reduce relapses and steroid need.

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🏡 Lifestyle & Environmental Tips

Reducing your exposure to Aspergillus can help keep IgE from rising again.

🔹 Avoid:

• Damp or moldy areas

• Compost, rotting leaves, hay, or soil dust

• Rooms with poor ventilation

🔹 Use:

• Ventilate your home well (eg open windows/extractor fans)

• A HEPA-filter air purifier at home

• An FFP2/FFP3 mask when doing dusty activities (gardening, cleaning mold)

🥗 Eat for Immune Support:

• Anti-inflammatory foods (vegetables, oily fish, berries)

• Reduce sugar (high sugar may promote inflammation)

• Stay well hydrated

• Ask your doctor about vitamin D — it may help regulate immunity

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📅 Follow-up Schedule (General examples, yours may differ)

Let your team know if any symptoms return — even if your last IgE result was stable.

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🧠 Final Thoughts

• You may always have “elevated” IgE compared to someone without ABPA — that’s okay. The goal is stability, not “zero IgE”.

• Many patients live well with ABPA for years by learning to manage flare-ups early and avoiding fungal exposure.

• Ask your clinic about your personal IgE pattern — some people flare with small changes; others don’t.

• Support groups and educational resources (like aspergillosis.org) can help you stay informed and confident.

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📩 Have questions for your team?

Bring these up at your next appointment:

• Can I reduce my medication safely?

• Could I benefit from a biologic?

• How often should I check my IgE?

• How can I reduce exposure at home?