A randomised trial of vitamin D in acute‐stage allergic bronchopulmonary aspergillosis complicating asthma

Abstract

Summary Vitamin D has been demonstrated to have an immunomodulatory role in cystic fibrosis with allergic bronchopulmonary aspergillosis (ABPA). Herein, we evaluate supplemental vitamin D in acute‐stage ABPA complicating asthma. Thirty subjects were randomised to receive either prednisolone (n = 15, control) or prednisolone and oral vitamin D (n = 15, intervention arm). Serum vitamin D levels were significantly higher in the intervention versus the control arm, following therapy. The mean decline in total IgE at 2 months (primary outcome) was 10% higher in the intervention arm than the control arm; however, this was not statistically significant (48.6% vs 38.1%, P = 0.27). The percentage decline in total IgE after 4 and 6 months of randomisation was also similar in the two arms. There was no difference in asthma exacerbations (0 vs 2, intervention vs control; P = 0.16). No ABPA exacerbation occurred in either arm. The other outcomes including the Th2 (IL‐4, IL‐6 and IL‐10) and Th17 (IL‐17) cytokine levels were similar in the two groups. None of the participants experienced hypervitaminosis D. There was no significant improvement in the clinical or immunological outcomes following vitamin D supplementation. A larger trial is required to ascertain the role of vitamin D in ABPA complicating asthma [Clinicaltrials.gov: NCT03133299].

Proposed Neuroimmune Roles of Dimethyl Fumarate, Bupropion, S-Adenosylmethionine, and Vitamin D3 in Affording a Chronically Ill Patient Sustained Relief from Inflammation and Major Depression

“…The combination of low 25(OH)D 3 and high 1,25(OH) 2 D 3 serum values is used to denote poor bone and immune health, Figure 7 . Vit-D3 deficiencies are proposed to cause: Skeletal maladies such as osteomalacia (bone softening), osteoporosis (bone brittleness), and rickets (bone deformation) [ 147 , 148 , 149 , 150 , 151 ]; Inflammatory autoimmune diseases, viz-a-vie, rheumatoid arthritis, systemic lupus erythematosus, multiple sclerosis, diabetes mellitus, and cancers [ 136 , 146 , 147 , 148 , 149 , 150 , 151 ], Increased susceptibility to viral, bacterial, and fungal infections [ 137 , 138 , 152 , 153 , 154 ]; and MD, which can lead to suicide [ 139 , 140 , 141 ]. …”

“…Increased serum 1,25(OH) 2 D 3 denotes depletion of 25(OH)D 3 in inflammatory illnesses and infections (see text).Optimum doses for dietary vitamin D supplementation for all age groups and both sexes are not known. C-3-epi-25OHD 3 is also known; however, not much is known about its physiological chemistry in humans[132][133][134][135][136][137][138][139][140][141].…”

Current Approach in the Diagnosis and Management of Allergic Bronchopulmonary Aspergillosis in Children With Cystic Fibrosis

“…A third dose regimen of prednisolone different from the other two above (0.5 mg•kg −1 •day −1 for 4 weeks, 0.25 mg•kg −1 •day −1 for 4 weeks, 0.125 mg•kg −1 •day −1 for 4 weeks, then taper by 5 mg every 2 weeks and discontinue after 4 months) was associated with 100% early composite response at 6 weeks (clinical, immunologic, and radiologic improvement) in three studies of patients with asthma with ABPA (92)(93)(94). Therefore, the third regimen may offer the right balance between early treatment response and toxicity.…”

Allergic bronchopulmonary aspergillosis

“…In ABPA, several defects in innate and adaptive immunity have been identified that lead to persistence of A. fumigatus and a distorted immune response Table II 3 35 36 37 38 39 40 41 . Vitamin D deficiency has been proposed as a pathogenetic factor in ABPA complicating CF 42 43 ; however, its role in ABPA complicating asthma is uncertain 44 45 .…”