The allergic aspergillosis syndromes are treated by removal of the inciting antigen, by judicious use of glucocorticoids, and by desensitization for patients with asthmatic symptoms. The effectiveness of desensitization, however, is debatable. The use of electrostatic dust filters in the homes of patients has been shown to be effective in removing the inciting antigen and improving clinical status. Adjunctive therapy with itraconazole may be of value for this condition, particularly in patients requiring corticosteroids. Systemic antifungal therapy for Aspergillus mycetomas is of no value.
Surgical excision is the treatment of choice.
The extent of underlying lung disease is a major predictor of outcome. Although surgical removal of all mycetomas has been recommended, it appears more logical to individualize therapy. For patients with significant hemoptysis but too little pulmonary reserve to permit surgical excision, intracavitary insufflation of amphotericin B may provide some benefit.