The effects of antifungal therapy on severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis.
نویسندگان
چکیده
BACKGROUND AND OBJECTIVE Very little is known about the response rates to or appropriateness of treatment for patients with allergic fungal diseases of the lung. This study assessed the effect of antifungal therapy in patients with severe asthma with fungal sensitization (SAFS) and allergic bronchopulmonary aspergillosis (ABPA). METHODS A retrospective cohort study of 33 adult patients who fulfilled the criteria for either SAFS (n = 22) or ABPA (n = 11) was conducted. All patients had received antifungal therapy for at least 6 months. The primary study end point was the effect of antifungal therapy on patients' lung function. RESULTS Overall, total IgE values and radioallergosorbent test (RAST) for A. fumigatus markedly decreased after 6 months of therapy in both SAFS and ABPA patients (P = 0.004 and P = 0.005, respectively). Reduction was seen in the eosinophil count (P = 0.037), dose of oral steroids (P = 0.043) and courses of systemic steroids required (P = 0.041). Lung function also improved (P = 0.016). Four of 10 patients discontinued oral steroids after 6 months of therapy. Reduction in IgE levels (P = 0.015) and RAST for A. fumigatus was also observed (P = 0.006) for those patients treated for at least 1 year with antifungal drugs. CONCLUSIONS Both ABPA and SAFS patients benefited from oral antifungal therapy. The antifungal therapy may act by reducing the antigenic load, interacting with corticosteroids or by a direct immunological effect.
منابع مشابه
Antifungals in severe asthma.
PURPOSE OF REVIEW Despite guideline-based treatment, many patients with severe asthma continue to have uncontrolled disease. Fungal allergy is being increasingly recognized in the pathogenesis of severe asthma. Limited data exist on the approach to treatment of fungal asthma. This review summarizes existing evidence on the use of antifungal agents in allergic bronchopulmonary aspergillosis (ABP...
متن کاملGenetic susceptibility to severe asthma with fungal sensitization.
Severe asthma is problematic and its pathogenesis poorly understood. Fungal sensitization is common, and many patients with severe asthma with fungal sensitization (SAFS), used to denote this subgroup of asthma, respond to antifungal therapy. We have investigated 325 haplotype-tagging SNPs in 22 candidate genes previously associated with aspergillosis in patients with SAFS, with comparisons in ...
متن کاملAllergic bronchopulmonary aspergillosis.
Allergic bronchopulmonary aspergillosis is an uncommon but serious respiratory condition characterized by chronic airway inflammation and airway damage resulting from persistent colonization by and sensitization to the fungus Aspergillus fumigatus. The immunopathogenesis of allergic bronchopulmonary aspergillosis involves several pathways. Aspergillus allergens stimulate an interleukin 5-mediat...
متن کاملSevere asthma and fungi: current evidence.
Bronchial asthma is an inflammatory disease of the airways which may be worsened due to numerous extrinsic factors. The most common trigger is continuous exposure to allergens of which fungal agents are important factors. There is overwhelming evidence for the presence of fungal sensitization in patients with asthma. The diagnosis of fungal sensitization can be made either with skin testing wit...
متن کاملCan Controlling Endoplasmic Reticulum Dysfunction Treat Allergic Inflammation in Severe Asthma With Fungal Sensitization?
Severe asthma is a heterogeneous disease entity to which diverse cellular components and pathogenetic mechanisms contribute. Current asthma therapies, including new biologic agents, are mainly targeting T helper type 2 cell-dominant inflammation, so that they are often unsatisfactory in the treatment of severe asthma. Respiratory fungal exposure has long been regarded as a precipitating factor ...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید
ثبت ناماگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید
ورودعنوان ژورنال:
- Respirology
دوره 14 8 شماره
صفحات -
تاریخ انتشار 2009