Allergic bronchopulmonary aspergillosis follows a relapsing course in a subset of patients. When the first-line single-agent approach does not produce the expected clinical and serological improvement at 8–12 weeks, a structured next-line protocol addresses recurrent exacerbations.
Initial therapy with oral prednisolone (monotherapy) or oral itraconazole (monotherapy) did not achieve a good response at 8–12 weeks — defined as major improvement in symptoms and chest radiographs together with at least a 20% reduction in serum total IgE.
For recurrent ABPA exacerbations, the protocol moves to a combination of two oral agents given concurrently — a corticosteroid and an antifungal — each continued over a multi-month course. The complete regimen, including agents, dosing parameters, and the full management algorithm, is available in the structured protocol below.
A combination of oral prednisolone and itraconazole should be used for treating recurrent (≥2 in the last 1–2 years) ABPA exacerbations (LoC: 71.4%).
Frequent: oral glucocorticoids (4 months) and itraconazole (4 months)
A good response is indicated by a major improvement in symptoms (Likert score or VAS ≥50%) and chest radiographs, along with at least a 20% reduction in serum total IgE.
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