Allergic aspergillosis syndromes
Allergic bronchopulmonary aspergillosis (ABPA)
- Allergic response to fungal hyphae in bronchial tree, manifesting as sinusitis and asthma and characterized by wheezing and pulmonary infiltrates, leading to bronchiectasis and fibrosis.
- Corticosteroids are primary therapy.
- Recommend treating:
- symptomatic asthmatic patients with bronchiectasis or mucoid impaction despite corticosteroid therapy
- CF patients with frequent exacerbations or falling FEV to minimize corticosteroid use.
Usual Pathogens
Aspergillus spp
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Itraconazole | 200mg PO bid | 3-6 months |
Alternative
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Voriconazole | 200mg PO bid | 3-6 months |
Allergic rhinosinusitis caused by Aspergillus
- Polypectomy and sinus washout with intranasal corticosteroids.
- Antifungal therapy (itraconazole 200mg PO bid) reserved for refractory or relapsing infection.