title: Itraconazole as 'bridge therapy' to anti-IgE in a patient with severe asthma with fungal sensitisation.
abstract: Sensitisation to fungi has been reported to play an important role in a particular phenotype of severe asthma, the so-called severe asthma with fungal sensitisation, characterised by high levels of total IgE, which may be an obstacle to anti-IgE therapy. We describe here the case of a polysensitised woman with refractory asthma, sensitised to Aspergillus fumigatus with high total IgE values (1793 kUA/l), but without the diagnostic criteria for allergic bronchopulmonary aspergillosis. Additional therapy with itraconazole leads to the decrease of total IgE to the limits recommended for proper omalizumab dosing (30-1500 kUA/l). Itraconazole, used as bridge therapy, provided us the opportunity to start anti-IgE treatment in a patient with high levels of total IgE, beyond the upper limits recommended for proper prescription of omalizumab.
authors.affiliation: Department of Allergy and Clinical Immunology, University of Torino & AO Ordine Mauriziano, Torino, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Pizzimenti
authors.forename: Claudia
authors.initials: C
authors.lastname: Bussolino
authors.forename: Iuliana
authors.initials: I
authors.lastname: Badiu
authors.forename: Giovanni
authors.initials: G
authors.lastname: Rolla
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D000888:Antibodies, Anti-Idiotypic / Q000276:immunology / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology*; D001232:Aspergillus fumigatus / Q000276:immunology*; D001249:Asthma / Q000188:drug therapy* / Q000276:immunology* / Q000382:microbiology*; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D017964:Itraconazole / Q000627:therapeutic use*; D008875:Middle Aged; D000069444:Omalizumab; D012129:Respiratory Function Tests
chemical_list: D018927:Anti-Asthmatic Agents; D000888:Antibodies, Anti-Idiotypic; D061067:Antibodies, Monoclonal, Humanized; D000935:Antifungal Agents; C026408:anti-IgE antibodies; D000069444:Omalizumab; D017964:Itraconazole; D007073:Immunoglobulin E