Itraconazole treatment of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Allergy. 2002 Aug;57(8):723-8. doi: 10.1034/j.1398-9995.2002.23583.x.


Background: Allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is a potentially fatal inflammatory disease due to the dual-type immune response provoked by the fungal antigens. Despite serious side effects long-term treatment with corticosteroids is often required. Itraconazole has been reported to be a useful steroid-sparing agent.

Methods: In a retrospective follow-up of 21 CF patients from a total of 250 treated once or twice within a five-year study period (1994-98), 9 patients were treated with systemic glucocorticosteroids in combination with itraconazole and 12 patients were treated with itraconazole (200-600 mg/day) as monotherapy.

Results: During treatment the percentage of Aspergillus fumigatus (AF)-positive sputum cultures significantly reduced (P < 0.05); precipitating antibodies to AF decreased significantly in all patients (P < 0.05); forced expiratory volume (FEV1) increased to pre-exacerbation level; total IgE levels decreased in 42% of patients on monotherapy and in 56% on combination therapy. Specific IgE (radioallergosorbant; RAST) level decreased in 6 of 21 patients. Eleven patients had transient increased levels of alanine transaminase (ALAT). One patient had isolated increase in alkaline phosphatase and another in aspartate transaminase (ASAT).

Conclusions: High dose itraconazole as monotherapy or in combination with systemic glucocorticosteroids seems effective in CF patients with ABPA. No hepatotoxicity was observed during long-term therapy.

Publication types

  • Comparative Study

MeSH terms

  • Antibodies, Fungal / analysis
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / therapeutic use*
  • Aspergillosis, Allergic Bronchopulmonary / complications*
  • Aspergillosis, Allergic Bronchopulmonary / drug therapy*
  • Aspergillosis, Allergic Bronchopulmonary / microbiology
  • Aspergillosis, Allergic Bronchopulmonary / physiopathology
  • Aspergillus fumigatus / immunology
  • Aspergillus fumigatus / isolation & purification
  • Cystic Fibrosis / complications*
  • Dose-Response Relationship, Drug
  • Drug Therapy, Combination
  • Eosinophils / pathology
  • Female
  • Follow-Up Studies
  • Forced Expiratory Volume
  • Glucocorticoids / therapeutic use
  • Humans
  • Immunoglobulin E / analysis
  • Itraconazole / administration & dosage
  • Itraconazole / therapeutic use*
  • Leukocyte Count
  • Liver / physiopathology
  • Male
  • Prednisolone / therapeutic use
  • Retrospective Studies
  • Sputum / microbiology


  • Antibodies, Fungal
  • Antifungal Agents
  • Glucocorticoids
  • Itraconazole
  • Immunoglobulin E
  • Prednisolone