Severe asthma with fungal sensitization in a child: response to itraconazole therapy.
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.
Vicencio
Alfin G
AG
Department of Pediatrics, Children's Hospital at Montefiore and Albert Einstein College of Medicine, Bronx, New York, USA. didivincencio@yahoo.com
Muzumdar
Hiren
H
Tsirilakis
Kalliope
K
Kessel
Aaron
A
Nandalike
Kiran
K
Goldman
David L
DL
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
D000935:Antifungal Agents; D017964:Itraconazole; D007073:Immunoglobulin E