People living with ABPA sometimes also experience severe asthma, chronic sinus inflammation and nasal polyps that return after surgery. These may appear to be separate problems, but they can be driven partly by the same type of immune response.
This has created an important new treatment possibility. Instead of repeatedly treating the nose and lungs as unrelated problems, a biological medicine may sometimes reduce inflammation in both.
Dupilumab (brand name Dupixent) is one such biologic. It is an established treatment for selected people with severe chronic rhinosinusitis with nasal polyps and for some forms of asthma. Early clinical-trial evidence also suggests that it may benefit some people with asthma and allergic bronchopulmonary aspergillosis (ABPA), although it is not currently licensed specifically as an ABPA treatment.
Key points
- Dupilumab can shrink severe nasal polyps, improve nasal blockage and help some people regain their sense of smell.
- It can also improve suitable forms of asthma because the nose and lungs may share the same type of inflammation.
- Promising results have been reported from a randomised phase 2 trial in people with both asthma and ABPA.
- Dupilumab does not kill Aspergillus and is not a replacement for antifungal treatment when antifungals are needed.
- The most suitable biologic should ideally be chosen jointly by ENT, respiratory and severe-asthma specialists.
Why do nasal polyps keep returning?
Nasal polyps are soft, non-cancerous swellings that develop from chronically inflamed tissue inside the nose and sinuses. They can cause:
- persistent nasal blockage;
- loss or reduction of smell;
- an apparent loss of taste, because much of what we experience as flavour depends on smell;
- nasal discharge or post-nasal drip;
- facial pressure; and
- poor sleep and fatigue.
Functional endoscopic sinus surgery (FESS) can remove polyps, improve drainage and allow nasal treatments to reach the sinuses more effectively. However, surgery removes the obstructing tissue; it does not necessarily switch off the inflammation that caused it. In people with strong ongoing inflammation, polyps may therefore grow back—occasionally quite quickly.
A nasal endoscopy shows what is visible inside the nose, while a CT scan helps the ENT team assess the full extent of inflammation and blockage throughout the sinuses. The results help determine whether further surgery, medical treatment or a biologic is the most appropriate next step.
The link between the nose, asthma and ABPA
The upper and lower airways form one connected system. Many people with nasal polyps also have asthma, and both conditions are frequently associated with type 2 inflammation.
In this pattern of inflammation, immune signals including interleukin-4 (IL-4), interleukin-13 (IL-13), interleukin-5, immunoglobulin E (IgE) and eosinophils can contribute to swelling, mucus production and airway symptoms.
ABPA is more complicated because it involves an exaggerated immune response to Aspergillus, usually in a person with asthma, bronchiectasis or another susceptible airway condition. Nevertheless, type 2 inflammation is also an important part of ABPA. This overlap creates the possibility that a treatment targeting one pathway could benefit more than one part of the airway.
However, having both ABPA and nasal polyps does not automatically mean that Aspergillus is growing in the sinuses. Allergic fungal rhinosinusitis is a separate diagnosis requiring its own ENT assessment. You can read more in our guide to Aspergillus and allergic fungal disease in the sinuses.
How does dupilumab work?
Dupilumab is a monoclonal antibody—a highly targeted biological medicine. It attaches to part of the receptor used by both IL-4 and IL-13, reducing signals that drive type 2 inflammation.
It is not a general immune suppressant in the way that oral corticosteroids are, and it is not an antifungal drug. It targets a particular inflammatory pathway rather than killing Aspergillus.
For adults with severe nasal polyps, dupilumab is normally given by injection under the skin, commonly every two weeks. After training, many people can administer it themselves. It is generally used as ongoing maintenance treatment rather than as a short, fixed course, and prescribed nasal corticosteroid treatment is usually continued.
How much can it help nasal polyps?
In the large SINUS-24 and SINUS-52 clinical trials, adding dupilumab to standard nasal corticosteroid treatment reduced polyp size and nasal congestion, improved sinus-related quality of life and improved sense of smell. Across the pooled trial population, it also substantially reduced the need for systemic corticosteroids and further sinus surgery.
Some people notice an improvement in congestion relatively early, but regaining smell and achieving the full benefit may take longer. Not everyone responds, and a completely normal sense of smell cannot be guaranteed—particularly if olfactory nerves have been affected by longstanding disease or another cause.
What do we know about dupilumab in ABPA?
Biologics are already used in selected people with severe asthma and treatment-dependent ABPA, particularly when repeated courses of oral corticosteroids are needed. The 2024 international ISHAM-ABPA guidelines recognised biologics as an option for treatment-dependent disease, but they are not recommended as routine first-line treatment for a new acute ABPA episode.
The phase 2 LIBERTY ABPA AIRED trial was the first randomised placebo-controlled study of dupilumab in adults with asthma and ABPA. It enrolled 62 participants. Results presented at respiratory conferences in 2025 reported improvements in lung function and quality of life, together with fewer severe respiratory exacerbations and reduced corticosteroid use.
These findings are encouraging and provide stronger evidence than earlier case reports. However, the study was small and the findings have so far principally been reported in conference abstracts. Dupilumab is therefore best described as a promising emerging treatment for ABPA, not a proven cure or a licensed ABPA treatment.
It is also important to distinguish control of inflammation from control of fungal growth. Dupilumab may calm the allergic response, but it does not remove Aspergillus from the airway and will not replace antifungal medication when a specialist believes antifungal treatment is required.
Who can receive dupilumab for nasal polyps on the NHS?
In February 2026, NICE recommended dupilumab as an add-on to intranasal corticosteroids for a defined group of adults in England with severe chronic rhinosinusitis with nasal polyps.
The NICE criteria include:
- disease that remains inadequately controlled by systemic corticosteroids or sinus surgery;
- at least one previous sinus operation; and
- a score of at least 50 on the 22-item Sinonasal Outcome Test (SNOT-22).
SNOT-22 is a questionnaire measuring the effect of sinus symptoms on daily life, including blockage, smell and taste, sleep, fatigue, concentration and emotional wellbeing. A polyp “stage” seen during nasal endoscopy is useful clinical information, but it is not by itself the same as meeting the full NHS eligibility criteria.
Access arrangements can differ outside England and may change over time. A specialist team must assess eligibility and whether dupilumab is the best option for the individual.
Choosing a biologic when several conditions overlap
Dupilumab is not the only biologic used in airway disease. Other medicines target IgE, IL-5, the IL-5 receptor or TSLP. The best choice depends on the complete clinical picture, which may include:
- the severity and recurrence of nasal polyps;
- asthma control and the number of exacerbations;
- ABPA activity and previous treatments;
- blood eosinophil levels and fractional exhaled nitric oxide (FeNO);
- total IgE and allergen-specific IgE;
- the need for repeated or maintenance oral steroids;
- other conditions such as eczema; and
- previous response or side effects with another biologic.
For someone with severe recurrent nasal polyps, asthma and ABPA, dupilumab may be particularly attractive because it has the potential to address inflammation in both the upper and lower airways. However, another biologic may be a better match for some patients. Ideally, ENT and respiratory or severe-asthma teams should coordinate the decision rather than considering each condition in isolation.
For a broader explanation, see how NHS specialists choose biologics for ABPA and severe asthma.
What are the possible side effects?
Dupilumab is generally well tolerated, but possible adverse effects include:
- redness, swelling, itching or discomfort at the injection site;
- eye irritation or conjunctivitis;
- joint pain;
- cold sores; and
- a temporary rise in blood eosinophils.
Serious allergic reactions are rare. New or worsening eye symptoms, marked joint symptoms, a rash, breathing deterioration or other concerning symptoms should be reported to the treating team. Patients should not stop asthma inhalers, nasal treatment, corticosteroids or antifungals when starting a biologic unless their specialist provides a supervised plan.
A note about IgE and IgG
Patients understandably sometimes refer to having a “high IgG” or a “high allergy count”, but several different antibody tests may be used in ABPA.
- Total IgE reflects overall allergic activity and is commonly followed over time in ABPA.
- Aspergillus fumigatus-specific IgE demonstrates allergic sensitisation to the fungus.
- Aspergillus-specific IgG can provide evidence of immune exposure and forms part of the wider diagnostic picture, but it is not interchangeable with total IgE.
Biologic treatment can alter inflammatory markers, so blood results must be interpreted alongside symptoms, lung function and imaging rather than in isolation.
Questions to ask your specialist team
- Do my symptoms and SNOT-22 score meet the criteria for biologic treatment?
- Is my loss of smell likely to be caused entirely by polyps, or should other causes be considered?
- Could one biologic reasonably treat both my nasal disease and asthma?
- How active is my ABPA at present, and what benefit might the biologic provide?
- Will my ENT and respiratory or severe-asthma teams discuss the choice together?
- How and when will my response be assessed?
- Which nasal sprays, rinses, inhalers or other treatments should I continue?
The outlook
For people whose polyps return quickly after surgery, being told that another operation is unlikely to solve the underlying problem can be disappointing. The arrival of biologic treatment changes that conversation. It offers a way of targeting the inflammation that drives polyp regrowth rather than repeatedly removing its consequences.
For patients who also have asthma and ABPA, the possibility is especially interesting: one targeted treatment may sometimes benefit the whole airway. It will not be the right answer for everybody, and it does not replace careful ABPA monitoring or antifungal treatment when needed. Nevertheless, it represents a significant and increasingly evidence-based addition to care.
Sources and further reading
- NICE: Dupilumab for treating severe chronic rhinosinusitis with nasal polyps (2026).
- Bachert C, et al. Dupilumab in severe chronic rhinosinusitis with nasal polyps: SINUS-24 and SINUS-52. The Lancet (2019).
- Revised ISHAM-ABPA working group clinical practice guidelines. European Respiratory Journal (2024).
- Bourdin A, et al. Dupilumab efficacy in asthma and ABPA: LIBERTY ABPA AIRED. European Respiratory Journal conference abstract (2025).
- Dupixent UK Summary of Product Characteristics.
This information is intended to support, not replace, discussion with your medical team. Treatment eligibility and the balance of benefits and risks must be assessed individually.
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