The effects of antifungal therapy on severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis.
OBJECTIVE
Very little is known about the response rates to or appropriateness of treatment for patients with allergic fungal diseases of the lung. This study assessed the effect of antifungal therapy in patients with severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA).


METHODS
A retrospective cohort study of 33 adult patients who fulfilled the criteria for either SAFS (n = 22) or ABPA (n = 11) was conducted. All patients had received antifungal therapy for at least 6 months. The primary study end point was the effect of antifungal therapy on patients' lung function.


RESULTS
Overall, total IgE values and radioallergosorbent test (RAST) for A. fumigatus markedly decreased after 6 months of therapy in both SAFS and ABPA patients (P = 0.004 and P = 0.005, respectively). Reduction was seen in the eosinophil count (P = 0.037), dose of oral steroids (P = 0.043) and courses of systemic steroids required (P = 0.041). Lung function also improved (P = 0.016). Four of 10 patients discontinued oral steroids after 6 months of therapy. Reduction in IgE levels (P = 0.015) and RAST for A. fumigatus was also observed (P = 0.006) for those patients treated for at least 1 year with antifungal drugs.


CONCLUSIONS
Both ABPA and SAFS patients benefited from oral antifungal therapy. The antifungal therapy may act by reducing the antigenic load, interacting with corticosteroids or by a direct immunological effect.
Pasqualotto
Alessandro C
AC
The University of Manchester, Manchester, UK. acpasqualotto@hotmail.com
Powell
Georgina
G
Niven
Robert
R
Denning
David W
DW
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology*; D001232:Aspergillus fumigatus / Q000276:immunology / Q000472:pathogenicity; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology*; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D017964:Itraconazole / Q000627:therapeutic use*; D008168:Lung / Q000382:microbiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011852:Radioallergosorbent Test; D012189:Retrospective Studies; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D017964:Itraconazole; D007073:Immunoglobulin E