Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis: a randomized controlled trial

J Allergy Clin Immunol. 2003 May;111(5):952-7. doi: 10.1067/mai.2003.1388.


Background: Allergic bronchopulmonary aspergillosis (ABPA) complicates chronic asthma and results from hypersensitivity to the fungus Aspergillus fumigatu s, causing an intense systemic immune response and progressive lung damage.

Objective: We sought to determine whether treatment with the antifungal agent itraconazole reduced eosinophilic airway inflammation in subjects with ABPA.

Methods: A randomized, double-blind, placebo-controlled trial was performed in stable subjects with ABPA (n = 29). Subjects received 400 mg of itraconazole per day (n = 15) or placebo (n = 14) for 16 weeks. All subjects were reviewed monthly with history, spirometry, and sputum induction to measure airway inflammation, serum total IgE and IgG levels to A fumigatu s, and blood eosinophil counts.

Results: By using regression analysis in a random-effects model, subjects receiving itraconazole had a decrease in sputum eosinophils of 35% per week, with no decrease seen in the placebo arm (P <.01). Sputum eosinophil cationic protein levels decreased with itraconazole treatment by 42% per week compared with 23% in the placebo group (P <.01). Itraconazole reduced systemic immune activation, leading to a decrease in serum IgE levels (310 IU/mL) compared with levels seen in the placebo group (increase of 18 IU/mL, P <.01) and a decrease in IgG levels to A fumigatu s (15.4 IU/mL) compared with levels seen in the placebo group (increase of 3.7 IU/mL, P =.03). There were fewer exacerbations requiring oral cortico-steroids in those treated with itraconazole compared with in the placebo group (P =.03).

Conclusion: Itraconazole treatment of subjects with stable ABPA reduces eosinophilic airway inflammation, systemic immune activation, and exacerbations. These results imply that itraconazole is a potential adjunctive treatment for ABPA.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Fungal / blood
  • Antifungal Agents / therapeutic use*
  • Aspergillosis, Allergic Bronchopulmonary / drug therapy*
  • Blood Proteins / analysis
  • Double-Blind Method
  • Eosinophil Granule Proteins
  • Humans
  • Immunoglobulin E / blood
  • Immunoglobulin G / blood
  • Inflammation / drug therapy*
  • Itraconazole / therapeutic use*
  • Ribonucleases*
  • Sputum / chemistry


  • Antibodies, Fungal
  • Antifungal Agents
  • Blood Proteins
  • Eosinophil Granule Proteins
  • Immunoglobulin G
  • Itraconazole
  • Immunoglobulin E
  • Ribonucleases