Tezepelumab as a Therapeutic Alternative in Allergic Bronchopulmonary Aspergillosis Suboptimally Controlled by Omalizumab.

Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity-mediated respiratory disorder complicating severe asthma, where management frequently requires prolonged systemic corticosteroid (SCS) administration. Although anti-IgE blockade with omalizumab is widely utilized as an SCS-sparing biologic, a subset of patients achieves only partial disease control. We present a clinical perspective and case observation of a 52-year-old female with stage III ABPA and persistent SCS dependence who exhibited a suboptimal response over a 5-year course of omalizumab. Following a therapeutic switch to tezepelumab (210 mg subcutaneously every 4 weeks)-a human monoclonal antibody targeting thymic stromal lymphopoietin (TSLP, an upstream epithelial alarmin)-the patient achieved complete clinical, functional, and structural remission within 12 months. Treatment efficacy was objectively confirmed using the EXACTO (10/10 points) and FEOS (100/100 points) validated severe asthma biologic response scales, alongside total SCS withdrawal and resolution of bronchial mucus impaction. Intercepting the type 2 (T2) inflammatory cascade at its origin via anti-TSLP therapy represents a highly compelling strategy for refractory ABPA phenotypes failing downstream targeted biologics.