An exacerbation of severe asthma with fungal sensitization successfully treated with voriconazole via a reduction of the fungal burden

Katsube, Otohiro; Kono, Yuta; Tsuzuki, Ryuta; Yamawaki, Satoshi; Soeda, Seiko; To, Masako; To, Yasuo

doi:10.1016/j.alit.2019.05.007

Cited by 2 publications

(2 citation statements)

References 9 publications

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“…In terms of acute asthma, there is a single case report of an 83 years old woman [55], with a 33-year history of asthma prescribed inhaled and oral corticosteroids. She presented with an acute attack of wheeze that did not respond to oral corticosteroids and antibiotics.…”

Section: Adult Datamentioning

confidence: 99%

Kids, Difficult Asthma and Fungus

Bush

2020

JoF

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Fungi have many potential roles in paediatric asthma, predominantly by being a source of allergens (severe asthma with fungal sensitization, SAFS), and also directly damaging the epithelial barrier and underlying tissue by releasing proteolytic enzymes (fungal bronchitis). The umbrella term ‘fungal asthma’ is proposed for these manifestations. Allergic bronchopulmonary aspergillosis (ABPA) is not a feature of childhood asthma, for unclear reasons. Diagnostic criteria for SAFS are based on sensitivity to fungal allergen(s) demonstrated either by skin prick test or specific IgE. In children, there are no exclusion criteria on total IgE levels or IgG precipitins because of the rarity of ABPA. Diagnostic criteria for fungal bronchitis are much less well established. Data in adults and children suggest SAFS is associated with worse asthma control and greater susceptibility to asthma attacks than non-sensitized patients. The data on whether anti-fungal therapy is beneficial are conflicting. The pathophysiology of SAFS is unclear, but the epithelial alarmin interleukin-33 is implicated. However, whether individual fungi have different pathobiologies is unclear. There are many unanswered questions needing further research, including how fungi interact with other allergens, bacteria, and viruses, and what optimal therapy should be, including whether anti-neutrophilic strategies, such as macrolides, should be used. Considerable further research is needed to unravel the complex roles of different fungi in severe asthma.

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Section: Adult Datamentioning

confidence: 99%

Kids, Difficult Asthma and Fungus

Bush

2020

JoF

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“…Os novos azoles, voriconazol e posaconazol, têm demonstrado eficácia terapêutica na ABPA (55) . O vori-conazol apresenta melhor biodisponibilidade oral e é mais bem tolerado (menos efeitos adversos gastrointestinais), todavia a fototoxicidade é mais frequente e está descrita uma associação com o aparecimento de cancro cutâneo na terapêutica a longo prazo (56) .…”

Section: Tratamentounclassified

Aspergilose broncopulmonar alérgica

Abreu¹,

Silva²,

Plácido³

2022

rpia

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A aspergilose broncopulmonar alérgica (ABPA) caracteriza-se por uma reação de hipersensibilidade complexa em resposta à colonização das vias aéreas pelo fungo Aspergillus fumigatus (Af). Após a inalação dos esporos de Af, a resposta imunológica pode variar de acordo com o doente, predominando mecanismos IgE-mediados. Esta doença é habitualmente diagnosticada em asmáticos com exacerbações frequentes ou em doentes com fibrose cística que apresentam deterioração clínica apesar da otimização terapêutica. Os critérios diagnósticos de ABPA atualmente utilizados datam de 2013. Contudo, esta doença implica uma abordagem diferencial diagnóstica complexa, sendo frequentemente subdiagnosticada. O tratamento da ABPA centra-se na utilização de corticoterapia e antifúngicos, sendo que os novos agentes biológicos, com eficácia terapêutica na asma grave, têm demonstrado ser promissores com bons resultados clínicos e analíticos. O objetivo desta revisão é apresentar os principais mecanismos fisiopatológicos, focando-se na abordagem clínica, diagnóstica e diferencial diagnóstica, bem como a abordagem terapêutica da ABPA.

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An exacerbation of severe asthma with fungal sensitization successfully treated with voriconazole via a reduction of the fungal burden

Cited by 2 publications

References 9 publications

Kids, Difficult Asthma and Fungus

Kids, Difficult Asthma and Fungus

Aspergilose broncopulmonar alérgica

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