Asthma, Rhinitis, Other Respiratory DiseasesAnti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis: A randomized controlled trial☆,☆☆
Section snippets
Subjects
Eligible subjects with clinically stable ABPA were recruited from the Department of Respiratory and Sleep Medicine at John Hunter Hospital. The diagnosis of ABPA was based on the criteria of Patterson and Greenberger,1, 6 with a pre-existing diagnosis of asthma, positive immediate skin prick test response to A fumigatus (wheal >2 mm), increased serum total IgE level (>1000 IU/mL), and increased serum IgG and IgE antibody levels specific to A fumigatus . Subjects were further divided into those
Subject characteristics at baseline
Thirty-four subjects were screened, and 29 eligible subjects were randomized to receive either itraconazole (n = 15) or placebo (n = 14). There were 2 withdrawals from the itraconazole arm. One subject had nausea that developed within 2 weeks of starting treatment, and the subject's symptoms resolved 48 hours after ceasing the medication. The other subject was involved in a motor vehicle accident and withdrew because of injuries. In the placebo arm the subject who withdrew fell and broke her
Discussion
In this randomized, double-blind, placebo-controlled study we have shown that in subjects with clinically stable ABPA, the addition of 400 mg of itraconazole daily reduces airway inflammation, with a reduction in sputum eosinophils and a significant decrease in sputum ECP levels. In addition, there was evidence of a reduction in systemic immune activation in those treated with itraconazole, with significant decreases in total serum IgE and IgG antibodies to A fumigatus , together with fewer
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Supported by NHMRC Australia.
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Reprint requests: Peter G. Gibson, Airways Infection and Immunology Research, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, NSW, 2310, Australia.