A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis.

BACKGROUND: Allergic bronchopulmonary aspergillosis is a hypersensitivity disorder that can progress from an acute phase to chronic disease. The main treatment is systemic corticosteroids, but data from uncontrolled studies suggest that itraconazole, an orally administered antifungal agent, may be an effective adjunctive therapy. METHODS: We conducted a randomized, double-blind trial of treatment with either 200 mg of itraconazole twice daily or placebo for 16 weeks in patients who met immunologic and pulmonary-function criteria for corticosteroid-dependent allergic bronchopulmonary aspergillosis. A response was defined as a reduction of at least 50 percent in the corticosteroid dose, a decrease of at least 25 percent in the serum IgE concentration, and one of the following: an improvement of at least 25 percent in exercise tolerance or pulmonary-function tests or resolution or absence of pulmonary infiltrates. In a second, open-label part of the trial, all the patients received 200 mg of itraconazole per day for 16 weeks. RESULTS: There were responses in 13 of 28 patients in the itraconazole group (46 percent), as compared with 5 of 27 patients in the placebo group (19 percent, P=0.04). The rate of adverse events was similar in the two groups. In the subsequent open-label phase, 12 of the 33 patients who had not had a response during the double-blind phase (36 percent) had responses, and none of the patients who had a response in the double-blind phase of the trial had a relapse. CONCLUSIONS: For patients with corticosteroid-dependent allergic bronchopulmonary aspergillosis, the addition of itraconazole can lead to improvement in the condition without added toxicity.

Reappraisal of intracutaneous tests in the diagnosis of reaginic allergy.

In an attempt to determine the clinical relevance of positive intracutaneous tests when epicutaneous tests are negative, 34 patients with symptoms of perennial rhinitis who had negative epicutaneous but positive intracutaneous tests were evaluated by radioallergosorbent (RAST) test, nasal provocation (NP) tests and leukocyte histamine release (LHR) assay. Nineteen patients with perennial rhinitis who had positive epicutaneous tests and 13 normal healthy volunteers were also studied as positive and negative controls, respectively. None of the 34 patients with negative epicutaneous but positive intracutaneous tests had positive RASTs or LHR assays, but 1 patient had a positive NP test. In contrast, of the 19 patients with positive epicutaneous tests, 12 patients had positive RASTs, 17 had positive LHR assays, and 17 had positive NP tests. In the negative control group of 13 subjects, none had positive RAST, LHR assays, or NP tests, although 3 subjects showed positive intracutaneous tests. These results indicate that when epicutaneous tests are negative in patients with perennial rhinitis, positive intracutaneous tests are not likely to indicate the presence of reaginic allergy.