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New Research - January 2009The fungus among us: Benign or not?This investigation was performed at four U.K. hospitals as part of the Fungal Asthma Sensitization Trial (FAST) study. The object of the study was to determine whether or not oral antifungal therapy was an effective adjunctive treatment in patients with severe asthma who showed sensitization to fungi as detected by skin tests or RAST. The rationale was based on the previous observations that such therapy is helpful in patients with allergic bronchopulmonary aspergillosis (ABPA), many severe asthmatics show sensitivity to fungal antigens, and there is at least one study citing improvement in a small number of asthmatics sensitized to trichophytin treated with fluconazole. This study was designed as a proof of concept investigation. Subjects with severe asthma and fungal sensitization (SAFS) were enrolled for a 32-week trial of therapy with itraconazole and a subsequent follow-up at 16 weeks after drug discontinuation. All subjects had a positive skin test or RAST to fungi. In order to rule out ABPA, subjects had a total IgE of less than 1,000 IU/ml and negative IgG aspergillus precipitins. The major endpoint was Asthma Quality of Life Questionnaire (AQLQ) score. They also assessed rhinitis symptoms, total IgE, peak flow, and pulmonary function. Significant improvement, compared to placebo, was seen in AQLQ, rhinitis score, and morning peak flow. In addition, there was also a significant decline in total serum IgE in the antifungal group. The authors concluded that antifungal therapy, as judged by a large improvement in AQLQ in 60% of patients, might be effective therapy for severe asthmatics sensitive to fungi. ReferenceDenning EW, et al. Randomized controlled trial of oral antifungal therapy for severe asthma with fungal sensitization. Am J Respir Crit Care Med 2009; 179:11-18.
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