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In the Literature, Clinical Infectious Diseases, Volume 48, Issue 3, 1 February 2009, Pages v–vi, https://doi.org/10.1086/596627
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Extract
Itraconazole for Asthma with Evidence of Fungal Sensitization
Denning DW, O'Driscoll BR, Powell G, et al. Randomized controlled trial of oral antifungal treatment for severe asthma with fungal sensitization (SAFS). Am J Resp Crit Care Med 2008 [Epub ahead of print].
Randomized, controlled trials have provided evidence of the benefits resulting from administration of itraconazole to patients with allergic bronchopulmonary aspergillosis (ABPA), and current Infectious Diseases Society of America guidelines make a high-level recommendation of such therapy [1]. Many patients with asthma who do not have ABPA nonetheless have evidence of sensitization to a variety of environmental fungi, leading to the hypothesis that this reactivity contributes to the disease process. Denning and colleagues previously identified a phenotype that they call severe asthma with fungal sensitization (SAFS) and recently randomized 58 patients with SAFS to receive either placebo or itraconazole capsules (200 mg twice per day) for 32 weeks, to evaluate the adjunctive role of antifungal therapy. Criteria for eligibility included severe manifestations of asthma with continuous receipt of inhaled or systemic corticosteroids (or repeated courses of the latter), positive results of a skin prick or radioaliergsorbent test for at least 1 fungal antigen, total circulating IgE level <1000 IU/mL, and a negative Aspergillus precipitin test result. The primary end point was the change from baseline at 32 weeks in the Asthma Quality of Life questionnaire (AQLQ) score (range, 1–7, with 7 representing a high quality of life).
