Itraconazole treatment of allergic bronchopulmonary aspergillosis


M Skov, N Høiby, C Koch
Allergy 2002: 57: 723-728


Background: Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis(CF) patients is a potentially fatal inflammatory disease due to the dual-typeimmune response provoked by the fungal antigens. Despite serious side effectslong-term treatment with corticosteroids is often required. Itraconazole has beenreported to be a useful steroid-sparing agent.Methods: In a retrospective follow-up of 21 CF patients from a total of 250treated once or twice within a five-year study period (1994-98), 9 patients weretreated with systemic glucocorticosteroids in combination with itraconazole and12 patients were treated with itraconazole (200-600 mg/day) as monotherapy.Results: During treatment the percentage of Aspergillus fumigatus (AF)-positivesputum cultures significantly reduced (P<0.05); precipitating antibodies to AFdecreased significantly in all patients (P<0.05); forced expiratory volume (FEV1)increased to pre-exacerbation level; total IgE levels decreased in 42% of patientson monotherapy and in 56% on combination therapy. Specific IgE (radioallergosorbant;RAST) level decreased in 6 of 21 patients. Eleven patients hadtransient increased levels of alanine transaminase (ALAT). One patient hadisolated increase in alkaline phosphatase and another in aspartate transaminase(ASAT).Conclusions: High dose itraconazole as monotherapy or in combination withsystemic glucocorticosteroids seems effective in CF patients with ABPA. Nohepatotoxicity was observed during long-term therapy.