Efficacy of dupilumab and biomarkers for systemic corticosteroid naïve allergic bronchopulmonary mycosis

Dear Editor, Allergic bronchopulmonary mycosis (ABPM) is caused by hypersensitive reaction to mycosis and worsened pulmonary function with developing airway dysfunction. The clinical characteristics are featured uncontrolled asthma with elevation of blood eosinophils and total immunoglobulin E (IgE), positive findings of the mycosis specific IgE and precipitating antibodies, chest radiological findings of central bronchiectasis and consolidation, existence of mucus plug. Systemic corticosteroid, which is pivotal treatment for acute stage of ABPM improves the pathophysiology however, long term corticosteroid administration causes adverse effect such as hyperglycemia, cataract, glaucoma, osteoporosis and severe infections associated with immune dysfunction. Here, we reported that beneficial effect of dupilumab, a novel biologic agent with blockade of interleukin (IL)-4 and IL-13 signals for systemic corticosteroid naive ABPM patients and clarified CD40 ligand (CD4OL) might be useful biomarker for ABPM.