Xolair®/desensitization

Question

Hello,
I am a 45 year-old woman with CF and allergic asthma (tested for trees, grases and fungi = Aspergillus). As the Symbicort® (formoterol and budesonide) is not enough anymore I have to do an additional therapy.
Which of the two therapies against the allergic asthma would you recommend to me: once a month a syringye of Xolair® (substance: omalizumab) or the desensitization or both? What are the advantages / disadvantages of both treatments in the long runs?
Many thanks and best regards,
S.

Answer

Dear S.,
this can not be answered like this as it is not easy in CF to say what are the symptoms of the allergic asthma (if present) and what is caused by the CF.
A desensitization or called specific immunotherapy today, is the more successful the younger the patients are, the shorter the symptoms and the fewer allergies are underlying. If there are many, so several grases and trees, the rate of success is small and in CF there is not any data. Very many patients are sensitized against Aspergillus and in case of worsening of symptoms one has also to look for a bronchopulmonary aspergillosis, which is not seldom in CF and which can make the same symptoms as a worsening of the asthma. Therefore at first this has to be excluded.
Xolair® is licensed for the case of severe allergic asthma - I cannot assess if you suffer from this. And then it depends on the level of the IgE- value, how much one has to give and if it makes sense.
In case you are seen at a pneumologist/ CF physician, please discuss this with him, in case he is not a pneumologist you should consult one, who then contacts your CF physician in order to find a suitable treatment.
Yours sincerely,
Prof. Dr. J. Bargon

13.05.2013