Severe uncontrolled asthma with biologic therapy in a pediatric patient : the role of fungal sensitization, a case report

We present the case of M., a girl followed by our Center since 2020 for severe asthma. After an initial positive response to Mepolizumab, she experienced multi- ple asthma exacerbations with poor response to conventional therapies, increased IgE levels, peripheral eosinophilia, and new sensitization to Aspergillus, rais- ing suspicion of Allergic Bronchopulmonary Aspergillosis (ABPA). Consequently, Mepolizumab was discontinued. However, due to insufficient diagnostic criteria to confirm ABPA, she was ultimately diagnosed with Severe Asthma with Fungal Sensitization (SAFS). Her environmental history revealed significant mold exposure at home. Following environmental remediation and the initiation of Dupilumab therapy, she showed clinical improvement.