BMJ Case Reports 2013; doi:10.1136/bcr-2012-008462

Itraconazole as ‘bridge therapy’ to anti-IgE in a patient with severe asthma with fungal sensitisation

  1. Giovanni Rolla
  1. Department of Allergy and Clinical Immunology, University of Torino & AO Ordine Mauriziano, Torino, Italy
  1. Correspondence to Professor Giovanni Rolla, grolla{at}


Sensitisation to fungi has been reported to play an important role in a particular phenotype of severe asthma, the so-called severe asthma with fungal sensitisation, characterised by high levels of total IgE, which may be an obstacle to anti-IgE therapy. We describe here the case of a polysensitised woman with refractory asthma, sensitised to Aspergillus fumigatus with high total IgE values (1793 kUA/l), but without the diagnostic criteria for allergic bronchopulmonary aspergillosis. Additional therapy with itraconazole leads to the decrease of total IgE to the limits recommended for proper omalizumab dosing (30–1500 kUA/l). Itraconazole, used as bridge therapy, provided us the opportunity to start anti-IgE treatment in a patient with high levels of total IgE, beyond the upper limits recommended for proper prescription of omalizumab.

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