Adjunctive Therapy of Allergic Bronchopulmonary Aspergillosis with Itraconazole

Denning, David W.; Wye, J.; Lewiston, Norman J.; Stevens, David A.

doi:10.1378/chest.100.3.813

Cited by 188 publications

(93 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…in patients with ABPA were disappointing [36,37]. However, case reports and uncontrolled series over several decades have reported treatment success upon addition of the Aspergillus-active oral triazole agent itraconazole to steroids for ABPA in asthma patients [38][39][40][41]. PACHECO et al [39] showed that itraconazole reduced specific IgG titres in a patient.…”

Section: Antifungal Therapy In Abpa and Safsmentioning

confidence: 99%

“…Extended courses of oral corticosteroids are considered first-line treatment for ABPA in asthma, and this is also the case in patients with CF [61][62][63][64][65]. As in asthma, itraconazole add-on therapy has been reported to be clinically beneficial in several uncontrolled studies of ABPA in CF patients [38,[44][45][46][47]. In these studies, reductions in oral steroid dose and stabilisation of lung function have been found.…”

Section: Antifungal Therapy In Abpa and Safsmentioning

confidence: 99%

See 1 more Smart Citation

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Moss

2013

Eur Respir J

View full text Add to dashboard Cite

Severe asthma with fungal sensitisation and allergic bronchopulmonary aspergillosis encompass two closely related subgroups of patients with severe allergic asthma. Pulmonary disease is due to pronounced host inflammatory responses to noninvasive subclinical endobronchial infection with filamentous fungi, usually Aspergillus fumigatus. These patients usually do not achieve satisfactory disease control with conventional treatment of severe asthma, i.e. high-dose inhaled corticosteroids and long-acting bronchodilators. Although prolonged systemic corticosteroids are effective, they carry a substantial toxicity profile. Supplementary or alternative therapies have primarily focused on use of antifungal agents including oral triazoles and inhaled amphotericin B. Immunomodulation with omalizumab, a humanised anti-IgE monoclonal antibody, or "pulse" monthly high-dose intravenous corticosteroid, has also been employed. This article considers the experience with these approaches, with emphasis on recent clinical trials. @ERSpublications Treatment of fungal asthma includes glucocorticoids, azoles, amphotericin and anti-IgE. Trial validation is needed.

show abstract

Section: Antifungal Therapy In Abpa and Safsmentioning

confidence: 99%

Section: Antifungal Therapy In Abpa and Safsmentioning

confidence: 99%

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Moss

2013

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Thus, a high fungal load detected in the quantitative culture of respiratory specimens of a RAO-affected horse may be a warning for the clinician to submit the animal to more specific diagnostic investigation or also to provide them with a more targeted drug therapy. In this context, an associated antifungal therapy can play an important role in RAO clinical resolution, eliminating fungal colonization of the respiratory tract and consequently the allergen, as already demonstrated in clinical trials in humans diagnosed with allergic bronchopulmonary aspergillosis (Denning et al, 1991;Wark et al, 2004) or with severe asthma with fungal sensitization (SAFS) (Denning et al, 2009), diseases similar to equine RAO.…”

Section: Discussionmentioning

confidence: 90%

Fungi in the respiratory tract of horses with recurrent airway obstruction

Xavier

Nogueira

Meirelles

et al. 2014

Arq. Bras. Med. Vet. Zootec.

View full text Add to dashboard Cite

This study aims to compare the concentration of viable fungi, especially those of the genus Aspergillus in the respiratory tract of stabled horses with and without Recurrent Airway Obstruction (RAO). Thirty two housed horses from four equestrian centers in Brazil were included in the study. These animals were submitted to clinical examination and to a respiratory sample collection. They were categorized into two groups: healthy and RAO-affected horses. Samples obtained by tracheobronchial washes were evaluated for fungal microscopy, quantitative culture and Aspergillus spp. quantification. Eighteen healthy and 14 RAO-affected horses were studied. Fungi were more frequently recovered in the RAO group, in comparison to controls, for both fungal microscopy (P<0.0001), fungal culture (P<0.0001) and Aspergillus spp. quantitative culture (p=0.001). In conclusion, horses with RAO have significantly higher fungal load in the respiratory tract in comparison to healthy horses. The implications of these findings in terms of the pathogenesis of RAO deserve additional investigation.Keywords: Aspergillus, tracheobronchial washes, respiratory allergy RESUMO Este estudo objetivou comparar a concentração de fungos viáveis, especialmente do gênero Aspergillus, no trato respiratório de equinos estabulados com e sem obstrução recorrente das vias aéreas (ORVA

show abstract

“…In this latter case, despite treatment with itraconazole alone the patient had recurrence of the mucous plugging. Symptom control was only achieved when itraconazole was used as an adjunctive treatment with steroids [9].…”

Section: Discussionmentioning

confidence: 99%

Allergic bronchopulmonary aspergillosis in lung allograft recipients

Egan

Yonan²,

Carroll³

et al. 1996

Eur Respir J

View full text Add to dashboard Cite

A Al ll le er rg gi ic c b br ro on nc ch ho op pu ul lm mo on na ar ry y a as sp pe er rg gi il ll lo os si is s i in n l lu un ng g a al ll lo og gr ra af ft t r re ec ci ip pi ie en nt ts s J.J. Egan * , N. Yonan ** , K.B. Carroll * , A.K. Deiraniya ** , A.K. Webb * , A.A. Woodcock * Allergic bronchopulmonary aspergillosis in lung allograft recipients. J.J. Egan, N. Yonan, K.B. Carroll, A.K. Deiraniya, A.K. Webb, A.A. Woodcock. ERS Journals Ltd 1996. ABSTRACT: Following lung transplantation for end-stage cystic fibrosis, two male patients presented with shortness of breath, peripheral blood eosinophilia and segmental lung collapse.At bronchoscopy, each had bronchial mucous plugging containing Aspergillus fumigatus. This finding was associated with a systemic eosinophilia and skin test positivity to Aspergillus. Augmented steroid therapy resulted in the successful resolution of the symptoms.We believe that these are the first reported cases of allergic bronchopulmonary aspergillosis in lung allograft recipients. Eur Respir J., 1996, 9, 169-171. Aspergillus fumigatus (Asp f) infection is associated with high morbidity and mortality following lung transplantation [1]. A spectrum of infection has been described ranging from colonization to invasive disease [1], but to date this has not included Aspergillus-induced allergymediated pulmonary dysfunction in lung transplant recipients. We describe two cases of allergic bronchopulmonary aspergillosis (ABPA) following lung transplantation for cystic fibrosis (CF). They provide insights into the pathogenesis of allergy-mediated airways disease. Case Reports Patient No. 1A 20 year old, 42 kg male patient received a double sequential lung transplantation for CF. The 15 year old donor had mild asthma requiring salbutamol on a p.r.n. basis and had previously been prescribed oral antihistamines for allergic rhinitis. The recipient was atopic with positive skin tests to Dermatophagoides pteronyssinus, grass pollen and Asp f extracts (8 mm weal, as an immediate type reaction). Prior to transplant, Aspergillus was not isolated from his sputum and he was Aspergillus precipitins negative. Four months following transplantation, the recipient underwent a routine surveillance transbronchial biopsy (TBB) which demonstrated moderate (A3a) rejection. He received 500 mg of methylprednisolone on three consecutive days. Twelve days later, he presented in respiratory failure (arterial oxygen tension (Pa,O 2 ) 4.6 kPa, arterial carbon dioxide tension (Pa,CO 2 ) 4.2 kPa) with collapse of the left lower lobe, which progressed over 24 h to show complete collapse

show abstract

Adjunctive Therapy of Allergic Bronchopulmonary Aspergillosis with Itraconazole

Cited by 188 publications

References 19 publications

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

Fungi in the respiratory tract of horses with recurrent airway obstruction

Allergic bronchopulmonary aspergillosis in lung allograft recipients

Contact Info

Product

Resources

About