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Aspergillosis 2016

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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).

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