Treatment of late-onset asthma with fluconazole
Treatment of late-onset asthma with fluconazole
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DOI：
10.1016/s0091-6749(99)70321-0
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发表时间：
1999-09-01
影响因子：
14.2
通讯作者：
Platts-Mills, TAE
中科院分区：
文献类型：
--
作者：
Ward, GW;Woodfolk, JA;Platts-Mills, TAE
背景资料：虽然内源性或迟发性哮喘的病因通常是未知的，但有些病例与明显的皮肤真菌感染和对来源于Trichophyton.Objective真菌的蛋白质的速发型超敏反应有关：我们试图通过安慰剂对照试验，用氟康唑测试口服抗真菌治疗毛癣菌诱导的哮喘的疗效。11例重度或中重度哮喘患者随机接受氟康唑100 mg/d或安慰剂治疗5个月（第1阶段）;在接下来的5个月内，所有患者均接受活性药物治疗（第2阶段）。通过皮肤试验、支气管激发试验和毛癣菌属抗原的血清抗体测量对受试者进行评价。通过在每个阶段结束时的2周期间测量的峰值流量值的变化以及通过支气管敏感性、症状和类固醇需求的变化来监测临床反应。在积极治疗的前5个月结束时，支气管对毛癣菌的敏感性显著降低（P = 0.012）和口服类固醇需求（P = 0.01），在第2阶段结束时，9例II型患者的平均呼气峰流速增加。症状的改善，峰值流量，和类固醇的使用，维持到36个月后，开始氟康唑的患者谁继续接受treatment.Conclusion：结果表明，氟康唑可以是有用的治疗重度或中度重度哮喘患者有皮肤真菌病。这些发现与皮肤和指甲上真菌衍生的蛋白质可能导致过敏性疾病的论点一致。
Background: Although the etiology of intrinsic or late-onset asthma is generally not known, some eases are associated with overt dermatophyte infection and immediate hypersensitivity to proteins derived from fungi of the genus Trichophyton.Objective: We sought to test the efficacy of oral antifungal treatment for Trichophyton-induced asthma by using fluconazole in a placebo-controlled trial.Methods: Eleven patients with severe or moderately severe asthma were randomized to treatment with fluconazole 100 mg daily or placebo for 5 months (phase 1); during the following 5 months, all patients received active drug (phase 2). Subjects were evaluated by skin tests, bronchial provocation tests, and measurement of serum antibodies to Trichophyton species antigens. Clinical response was monitored by changes in peak flow values measured during a 2-week period at the end of each phase and by changes in bronchial sensitivity, symptoms, and steroid requirements.Results: At the end of the first 5 months of active treatment, there was a highly significant decrease in bronchial sensitivity to Trichophyton (P = .012) and in oral steroid requirement (P = .01), At the end of phase 2, mean peak expiratory flow rates increased in 9 of II patients. An improvement in symptoms, peak flow, and steroid use was maintained up to 36 months after starting fluconazole in patients who continued to receive treatment.Conclusion: The results show that fluconazole can be useful in the treatment of patients with severe or moderately severe asthma who have dermatophytosis. These findings are consistent with the argument that proteins derived from fungi on the skin and nails can contribute to allergic disease.