title: Severe asthma with fungal sensitization in a child: response to itraconazole therapy.
abstract: People with severe asthma with fungal sensitization may represent an underdiagnosed subset of patients with refractory disease. It is important to know that such patients may benefit from adjunct treatment with antifungal agents. We describe here the case of a child with refractory asthma, persistent airway obstruction, a serum immunoglobulin E level of >20000 IU/mL, and severe eosinophilic airway infiltration. Although he did not meet diagnostic criteria for allergic bronchopulmonary aspergillosis, he demonstrated evidence of sensitization to several fungi and responded dramatically to the addition of itraconazole therapy. We also discuss emerging hypotheses regarding fungal-induced asthma.
authors.affiliation: Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, USA. didivincencio@yahoo.com
authors.forename: Alfin G
authors.initials: AG
authors.lastname: Vicencio
authors.forename: Hiren
authors.initials: H
authors.lastname: Muzumdar
authors.forename: Kalliope
authors.initials: K
authors.lastname: Tsirilakis
authors.forename: Aaron
authors.initials: A
authors.lastname: Kessel
authors.forename: Kiran
authors.initials: K
authors.lastname: Nandalike
authors.forename: David L
authors.initials: DL
authors.lastname: Goldman
mesh_terms: D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis / Q000188:drug therapy*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology; D001485:Basement Membrane / Q000276:immunology / Q000473:pathology; D001706:Biopsy; D001980:Bronchi / Q000276:immunology / Q000473:pathology; D001999:Bronchoscopy; D002648:Child; D005658:Fungi / Q000276:immunology*; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D017964:Itraconazole / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D011657:Pulmonary Eosinophilia / Q000188:drug therapy / Q000276:immunology; D012221:Rhinitis, Allergic, Perennial / Q000188:drug therapy* / Q000276:immunology
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole; D007073:Immunoglobulin E