Many people with ABPA who continue to experience flare-ups despite steroids and antifungals are now being offered biological therapies—also known as monoclonal antibodies.
These treatments target specific parts of the immune system involved in allergic inflammation. They’re often used when:
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Steroids are needed frequently or at high doses
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Antifungals alone aren’t enough
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ABPA keeps recurring and affecting quality of life
đź’‰ Biologics Currently Used in ABPA
The following biologics are being used in the UK, particularly in specialist centres and often in patients with ABPA plus severe asthma or eosinophilic disease:
| Biologic Name | Target | Brand Name | Notes |
|---|---|---|---|
| Omalizumab | IgE | Xolair | Most commonly used; good for high IgE and allergic asthma |
| Mepolizumab | IL-5 | Nucala | For eosinophilic inflammation; steroid-sparing |
| Benralizumab | IL-5 receptor (IL-5Rα) | Fasenra | Rapidly reduces eosinophils; monthly or 8-weekly injection |
| Dupilumab | IL-4 and IL-13 | Dupixent | Used in allergic-type asthma and some ABPA patients |
| Reslizumab | IL-5 | Cinqaero | IV infusion; less commonly used in ABPA |
| Tezepelumab | TSLP (upstream cytokine) | Tezspire | Newest option; blocks multiple inflammatory pathways; doesn’t require high IgE or eosinophils |
👉 Note: No biologic is officially licensed specifically for ABPA, but many are used off-label in patients with overlapping severe asthma or allergic disease.
âś… What Do Patients Say?
Many people treated with biologics report:
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Fewer flare-ups or “chest infections”
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Less need for oral steroids
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Clearer breathing, less coughing, and better energy
Not everyone responds, but many see significant improvement in control and quality of life.
⚠️ Side Effects
Biologics are generally well-tolerated. Possible side effects include:
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Mild injection site reactions (redness, swelling)
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Headaches or fatigue
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Allergic reactions (rare)
They’re usually given every 2–8 weeks as an injection under the skin, sometimes in hospital at first and then possibly at home.
đź©ş What to Ask Your Consultant
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Why have you chosen this biologic for me?
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Will it help my asthma as well as ABPA?
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How soon will I know if it’s working?
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Will I still need antifungals or steroids?
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Are there any alternatives if this one doesn’t work?
đź“Ś Summary
| Key Point | Biologics in ABPA |
|---|---|
| Used when | Steroids aren’t enough or cause side effects |
| Most used | Omalizumab, Mepolizumab, Tezepelumab |
| Goals | Reduce flares, improve breathing, lower steroid use |
| Licensed for ABPA? | ❌ No – but used off-label in many UK centres |
| NHS funding? | ✅ Yes – when criteria for severe asthma are met |
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