Itraconazole treatment of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis
Article first published online: 11 JUL 2002
Volume 57, Issue 8, pages 723–728, August 2002
How to Cite
Skov, M., Høiby, N. and Koch, C. (2002), Itraconazole treatment of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis. Allergy, 57: 723–728. doi: 10.1034/j.1398-9995.2002.23583.x
- Issue published online: 11 JUL 2002
- Article first published online: 11 JUL 2002
- Accepted for publication 5 March 2002
- allergic bronchopulmonary aspergillosis (ABPA);
- Aspergillus fumigatus;
- cystic fibrosis;
- liver function;
- precipitating antibodies;
Background: Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is a potentially fatal inflammatory disease due to the dual-type immune response provoked by the fungal antigens. Despite serious side effects long-term treatment with corticosteroids is often required. Itraconazole has been reported to be a useful steroid-sparing agent.
Methods: In a retrospective follow-up of 21 CF patients from a total of 250 treated once or twice within a five-year study period (1994–98), 9 patients were treated with systemic glucocorticosteroids in combination with itraconazole and 12 patients were treated with itraconazole (200–600 mg/day) as monotherapy.
Results: During treatment the percentage of Aspergillus fumigatus (AF)-positive sputum cultures significantly reduced ( P < 0.05); precipitating antibodies to AF decreased significantly in all patients ( P < 0.05); forced expiratory volume (FEV 1) increased to pre-exacerbation level; total IgE levels decreased in 42% of patients on monotherapy and in 56% on combination therapy. Specific IgE (radioallergosorbant; RAST) level decreased in 6 of 21 patients. Eleven patients had transient increased levels of alanine transaminase (ALAT). One patient had isolated increase in alkaline phosphatase and another in aspartate transaminase (ASAT).
Conclusions: High dose itraconazole as monotherapy or in combination with systemic glucocorticosteroids seems effective in CF patients with ABPA. No hepatotoxicity was observed during long-term therapy.