What is the role of medications in the treatment of mold-related allergic bronchopulmonary aspergillosis (ABPA) and allergic bronchopulmonary mycosis (ABPM)?

Updated: Dec 02, 2020
  • Author: Shih-Wen Huang, MD; Chief Editor: Harumi Jyonouchi, MD  more...
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A systemic corticosteroid is the treatment of choice. When indicated, supportive therapy may include the use of a high-potency inhaled corticosteroid, adrenergic agonists, nedocromil, or theophylline. The results of trials with antifungal agents have not been convincing.

Several reports appeared sporadically about the success of treating ABPA by using antifungal agents. The antifungal treatment ranged from the use of a combination of oral erythromycin and fluconazole, the use of oral itraconazole alone, or inhalation of amphotericin B alone. At the initial stage, most studies reported the concomitant use of a corticosteroid and these antifungal agents. However, these are only case reports.

A single dose of 300 mg of the anti-IgE antibody, omalizumab, resulted in a dramatic and rapid improvement of symptoms and lung function in a 12-year-old girl with cystic fibrosis and ABPA. [26] . Another recent report also showed good response for 2 pediatric patients with CF and ABPA after an injection with omalizumab. Their admission number was significantly decreased. Additionally, their free IgE level decreased by 87.9% in one and by 95.6% in the other. The authors suggested free IgE measurement is useful for monitoring the clinical response. [27]   

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