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Itraconazole as “bridge therapy” to anti-IgE in patients with severe asthma with fungal sensitization

Itraconazole as “bridge therapy” to anti-IgE in patients with severe asthma with fungal... Pizzimenti et al. Clinical and Translational Allergy 2013, 3(Suppl 1):P28 http://www.ctajournal.com/content/3/S1/P28 POSTER PRESENTATION Open Access Itraconazole as “bridge therapy” to anti-IgE in patients with severe asthma with fungal sensitization Stefano Pizzimenti , Enrico Heffler, Iuliana Badiu, Claudia Bussolino, Alberto Raie, Giovanni Rolla From EAACI International Severe Asthma Forum (ISAF 2012) Gothenburg, Sweden. 11-13 October 2012 Background decrease of total IgE (1043 kUA/l) was found, associated Sensitization to fungi has been reported to play an impor- to a mild improvement in asthma control (ACT from 16 tant role in a particular phenotype of severe asthma, the to 20). At that time, omalizumab was started at recom- so called severe asthma with fungal sensitization (SAFS), mended doses (300 mg every 2 weeks). During the six characterized by high levels of total IgE, which may be an months after anti-IgE therapy the patient did not report obstacle to anti-IgE therapy. A few studies showed the any asthma exacerbation and ACT score (23) showed benefit of antifungal therapy in improving the quality of the good control of asthma. life of patients with SAFS associated to a decrease of total IgE serum concentration. We describe here the role of Conclusion antifungal therapy as “bridge therapy”, which provided us Antifungal therapy, as add-on treatment in patients with the opportunity to start anti IgE therapy in one polysensi- SAFS, may provide the opportunity to start anti-IgE tized patient with severe asthma, who had very high levels therapy at usual recommended doses. of total IgE, beyond the upper limits recommended for proper prescription of omalizumab. Published: 3 May 2013 Method A 59-year-old woman with uncontrolled severe asthma doi:10.1186/2045-7022-3-S1-P28 and frequent exacerbations, which required oral steroids Cite this article as: Pizzimenti et al.: Itraconazole as “bridge therapy” to courses, while on therapy with LABA / high dose inhaled anti-IgE in patients with severe asthma with fungal sensitization. Clinical and Translational Allergy 2013 3(Suppl 1):P28. fluticasone and montelukast, was evaluated for possible allergic broncho-pulmonary aspergillosis (ABPA). Results The patient was sensitized to Aspergillus umigatus, Submit your next manuscript to BioMed Central house dust mites and grass pollen. She did not have and take full advantage of: Aspergillus precipitins and lung HRCT did not show bronchiectases or lung infiltrates, while she had very • Convenient online submission high levels of total IgE (1793 kUA/l), with specific grass, • Thorough peer review D. Pter and A. fumigatus IgE (respectively 15.3, 8.4 and • No space constraints or color figure charges 11.3 kUA/l). The patient received the diagnosis of SAFS • Immediate publication on acceptance and started itraconazole therapy (200 mg b.i.d.) as add- • Inclusion in PubMed, CAS, Scopus and Google Scholar on therapy for 12 weeks. After treatment, a significant • Research which is freely available for redistribution Submit your manuscript at University of Torino - AO Mauriziano Umberto I, Allergy and Clinical www.biomedcentral.com/submit Immunology, Italy © 2013 Pizzimenti et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Clinical and Translational Allergy Springer Journals

Itraconazole as “bridge therapy” to anti-IgE in patients with severe asthma with fungal sensitization

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Publisher
Springer Journals
Copyright
Copyright © 2013 by Pizzimenti et al; licensee BioMed Central Ltd.
Subject
Medicine & Public Health; Allergology; Immunology
eISSN
2045-7022
DOI
10.1186/2045-7022-3-S1-P28
Publisher site
See Article on Publisher Site

Abstract

Pizzimenti et al. Clinical and Translational Allergy 2013, 3(Suppl 1):P28 http://www.ctajournal.com/content/3/S1/P28 POSTER PRESENTATION Open Access Itraconazole as “bridge therapy” to anti-IgE in patients with severe asthma with fungal sensitization Stefano Pizzimenti , Enrico Heffler, Iuliana Badiu, Claudia Bussolino, Alberto Raie, Giovanni Rolla From EAACI International Severe Asthma Forum (ISAF 2012) Gothenburg, Sweden. 11-13 October 2012 Background decrease of total IgE (1043 kUA/l) was found, associated Sensitization to fungi has been reported to play an impor- to a mild improvement in asthma control (ACT from 16 tant role in a particular phenotype of severe asthma, the to 20). At that time, omalizumab was started at recom- so called severe asthma with fungal sensitization (SAFS), mended doses (300 mg every 2 weeks). During the six characterized by high levels of total IgE, which may be an months after anti-IgE therapy the patient did not report obstacle to anti-IgE therapy. A few studies showed the any asthma exacerbation and ACT score (23) showed benefit of antifungal therapy in improving the quality of the good control of asthma. life of patients with SAFS associated to a decrease of total IgE serum concentration. We describe here the role of Conclusion antifungal therapy as “bridge therapy”, which provided us Antifungal therapy, as add-on treatment in patients with the opportunity to start anti IgE therapy in one polysensi- SAFS, may provide the opportunity to start anti-IgE tized patient with severe asthma, who had very high levels therapy at usual recommended doses. of total IgE, beyond the upper limits recommended for proper prescription of omalizumab. Published: 3 May 2013 Method A 59-year-old woman with uncontrolled severe asthma doi:10.1186/2045-7022-3-S1-P28 and frequent exacerbations, which required oral steroids Cite this article as: Pizzimenti et al.: Itraconazole as “bridge therapy” to courses, while on therapy with LABA / high dose inhaled anti-IgE in patients with severe asthma with fungal sensitization. Clinical and Translational Allergy 2013 3(Suppl 1):P28. fluticasone and montelukast, was evaluated for possible allergic broncho-pulmonary aspergillosis (ABPA). Results The patient was sensitized to Aspergillus umigatus, Submit your next manuscript to BioMed Central house dust mites and grass pollen. She did not have and take full advantage of: Aspergillus precipitins and lung HRCT did not show bronchiectases or lung infiltrates, while she had very • Convenient online submission high levels of total IgE (1793 kUA/l), with specific grass, • Thorough peer review D. Pter and A. fumigatus IgE (respectively 15.3, 8.4 and • No space constraints or color figure charges 11.3 kUA/l). The patient received the diagnosis of SAFS • Immediate publication on acceptance and started itraconazole therapy (200 mg b.i.d.) as add- • Inclusion in PubMed, CAS, Scopus and Google Scholar on therapy for 12 weeks. After treatment, a significant • Research which is freely available for redistribution Submit your manuscript at University of Torino - AO Mauriziano Umberto I, Allergy and Clinical www.biomedcentral.com/submit Immunology, Italy © 2013 Pizzimenti et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Journal

Clinical and Translational AllergySpringer Journals

Published: May 3, 2013

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