14
Allergic Syndromes
Allergic Bronchopulmonary Aspergillosis
Î Elevated Aspergillus IgE and total IgE are recommended to establish
the diagnosis and are useful for screening (S-H).
Î The IDSA suggests treating symptomatic asthmatic patients
with bronchiectasis or mucoid impaction, despite oral or inhaled
corticosteroid therapy, with oral itraconazole therapy with
therapeutic drug monitoring (W-L).
Î In cystic fibrosis (CF) patients with frequent exacerbations and/
or falling FEV
1
, the IDSA suggests treating with oral itraconazole to
minimize corticosteroid use — with therapeutic drug monitoring and
consideration of other mold-active azole therapy if therapeutic levels
cannot be achieved. (W-L).
Allergic Aspergillus Rhinosinusitis
Î The IDSA recommends establishing the diagnosis of allergic fungal
rhinosinusitis (AFRS) in patients with nasal polyposis and thick
eosinophilic mucin by visualizing hyphae in mucus, which is supported
by a positive anti-Aspergillus IgE serum antibody assay or skin prick
test (where available) (S-M).
Î The IDSA recommends polypectomy and sinus washout as the optimal
means of symptom control and inducing remission. However, relapse
is frequent (S-M).
Î The IDSA recommends the use of topical nasal steroids to reduce
symptoms and increase time to relapse, especially if given after
surgery (S-M).
Î The IDSA suggests oral antifungal therapy using mold-active triazoles
for refractory infection and/or rapidly relapsing disease, although this
approach is only partially effective (W-L).
