Abstract: A 53-year-old female patient was diagnosed as allergic bronchopulmonary aspergillosis in March 2015. The patient was treated with oral glucocorticoid (methylprednisolone 6-20 mg/d for 4.5 years and prednisone 5-20 mg/d over 2 years) for 6.5 years. And patient’s condition was not well controlled. In June 2019, itraconazole was taken for more than one month, and it was discontinued due to adverse reactions such as edema of ankle, face, shoulder and skin pigmentation. The patient suffered from acute ABPA exacerbation repeatedly and disease progression. The levels of serum total immunoglobulin E (TIgE) and Aspergillus fumigatus specific immunoglobulin E (Af-sIgE) were higher. The biological agents were used after full evaluation and informed consent. Omalizumab was given off-label use (600 mg, q4w) in September 2021. After treatment, the patient gradually improved, the acute exacerbation was reduced, the condition was evaluated to be stable, and the dose of prednisone was gradually reduced to 5 mg/d.