Hi to you all,
Does any one know the next treatment for ABPA after anti fungal itraconazole? I was intolerant of this drug and started vomiting on it. My consultant at my local hospital is referring me to a London hospital for further treatment and I don’t know what that is yet. It is unlikely to be a different anti fungal drug because I have an ulcerated eosepagus and I think any anti fungal drug would irritate it. Can anyone help?
Rosie
In conversation about ABPA at my hospital a technitian told me that they treat it with nebulised antifungals. That may be an answer for you.
Thank you so much for replying Littlepom, that puts my mind ar rest. Had this condition for many years but not recognised.
I couldn't tolerate Itraconazole since my liver enzymes went too high. My abpa is now controlled with 5mg Prednisolone. I know lots of people are not keen on steroids but they work for me.
Hello jacmidlands,
Thank you for your reply. I currently take 10mg Prednisolone daily after three weeks on 30mg per day, then phasing down weekly to the current 10mg. I don’t like the side effects of steroids but I was so unwell, no choice, they have made me feel better. I am glad you have found what works for you. We all respond differently to our drugs and I am hopeful I will get to where you are with this condition controlled.
Not had to deal with this little blighter ourselves (yet), but under normal circumstances, where itraconazole isn’t well tolerated, then voriconazole is usually the next oral option along with steroids. You might find these treatment guidelines for aspergillosis/ABPA used at the Brompton by the adult CF unit helpful:
rbht.nhs.uk/healthprofessio...
There’s also this site, they have a Q&A/support section:
Hope that’s a little bit helpful. Good luck.
Thank you replying Charlie-G
I am glad there are alternative options to Intraconazole, this drug made me very ill. Inhaled anti fungal sounds good to me, I also take prednisalone. It is a complicated condition and different for each patient. My IgE was off the scale, 5,000 plus. Will have a look at the link. Wish you well too.
The Brompton link details a third line oral antifungal they use if voriconazole is intolerable (or not appropriate) and they do use an inhaled antifungal in some circumstances, but the bnf does not include nebulisation as a delivery route for it: that’s not particularly uncommon, but it does mean that unless there are compelling clinical grounds to skip the other orals, you might well have to try those first. Amphotericin (the drug they neb) can also be given IV, but so can the oral meds depending on need. From my decade in the cf community, my understanding is that anti-fungals are pretty harsh side effect wise on almost everyone, so it’s weighing up the pros of tackling the aspergillus that way and the cons of how they make you feel. Vomiting is clearly no good at all, but anything else just has to be balanced out, I think.
I don’t know a huge amount about the second site, other than to say several nhs hospitals list it as a source of further information. You’d hope that means they’re a reliable source! I’ve had a quick gander and it’s not the most user friendly site on mobile, but they seem to have every research paper on aspergillosis (and the treatment of it) known to man, so that would suggest they know their stuff.
Thank you Charlie-G
My problem is my ulcerated eosphegus, I stopped Itraconazole last Sunday and still I am very nauseas, I understand this drug stays in the system after stopping orally. My first attack of ABPA, I remember well, was in 1991, but was not officially diagnosed until 2008. I know it is a difficult condition to diagnose. Went on both sites, the Brompton one very informative, so thank you. I will just have to wait for my referral from my local hospital to a London one. I wonder if IV or inhaled antifungal can still give you nausea and vomiting? After all it is in your body. Meanwhile, I hope the prednisalone will keep me going, together with inhalers, I am asthmatic too.
I was put on Pozaconazole after Itraconazole
If you are on Facebook there is a very supportive group, well two actually.
Aspergillosis Support and Aspergillosis Support (Private) Just put those in the search box. You will have to send a request to join. Some of the members of the group nebulise anti fungals.
I may be wrong but Itraconazole can be prescribed by hospital consultants but only certain departments can prescribe Voricanazole and others because of cost. Two of the best centres are at The Brompton and the National Apergillosis Centre in Manchester.
Thank you the info, will check out the Aspergillus groups.
Mouth severe fungal infection
Anti-fungal medication 
ABPA and bronchiectasis 
I wonder if our members have any tips on how to build up ones immunity system.
