🧠 What Is Mindfulness? Can it Help Living With Aspergillosis?

Mindfulness can be a powerful support tool for people living with aspergillosis, whether it's CPA, ABPA, SAFS, or related conditions like bronchiectasis or asthma. It doesn’t replace medical treatment, but it can significantly help with coping, symptom awareness, and emotional wellbeing.

Below is a breakdown of how mindfulness practices may benefit people with aspergillosis:

Mindfulness means paying attention, on purpose, in the present moment, without judgment. It involves noticing your thoughts, feelings, and physical sensations — without getting caught up in them or trying to change them immediately.

This can be done through:

  • Breath awareness

  • Body scans

  • Guided meditation

  • Mindful movement (e.g. yoga, tai chi)

  • Mindful walking or eating

🌿 How Can Mindfulness Help with Aspergillosis?

Challenge How Mindfulness Helps
Breathlessness / coughing fits Helps calm panic and reduce over-breathing; improves awareness of breath patterns
Medication side effects (e.g. voriconazole) Reduces anxiety and fear responses; helps observe sensations without spiralling
Chronic fatigue / brain fog Supports pacing and acceptance; improves focus and attention
Pain or chest discomfort Helps reduce distress by observing pain without fighting it (used in pain management)
Anxiety or health fear Teaches how to sit with fear without letting it dominate thinking
Frustration with slow progress Encourages self-kindness and reduces reactivity to setbacks
Isolation / low mood Builds resilience and reduces rumination by shifting focus to what is happening now
Poor sleep Calms a racing mind before bedtime

🧘‍♀️ Simple Mindfulness Practices for Patients

1. Breath Awareness (1–2 minutes)

Focus gently on the in-breath and out-breath. When your mind wanders (and it will), gently bring it back to the breath.

Use when: You feel overwhelmed, panicked, or need to slow down.

2. Body Scan (5–10 minutes)

Lie or sit down, and slowly move your attention through your body from feet to head. Notice sensations — tension, warmth, numbness — without judgment.

Use when: Resting, falling asleep, or managing pain or fatigue.

3. Mindfulness in Everyday Tasks

Choose a task (e.g., washing up, brushing teeth, folding clothes). Do it slowly and notice the sensations, smells, sounds — staying fully present.

Use when: You feel disconnected or anxious during the day.

4. RAIN Method for Anxiety

  • Recognise what’s happening

  • Allow the experience to be there

  • Investigate with curiosity (Where in my body do I feel this?)

  • Nurture (What do I need right now?)

Use when: You’re feeling a strong emotional response (fear, frustration, sadness).

💬 What Patients Have Said

“It doesn’t stop the coughing, but I panic less when I feel it coming on.”
“I used to fear every twinge in my chest. Mindfulness gave me space before I reacted.”
“When I feel the visual side effects starting, I breathe and tell myself: just observe, it will pass.”

📱 Resources and Apps (Many Are Free)

  • Headspace (good for beginners)

  • Insight Timer (lots of free guided meditations)

  • Calm (for sleep and anxiety)

  • Breathworks (mindfulness for health conditions)

  • Smiling Mind (free and evidence-based)

⚠️ Important Notes

  • Mindfulness is a skill — it takes time and practice. Start small.

  • It can feel uncomfortable at first, especially if you're used to avoiding difficult thoughts or sensations.

  • If you’ve experienced trauma or distressing symptoms, guided mindfulness with a therapist may be safer.

by GAtherton

Visual Disturbances on Voriconazole: What’s Happening and Why It Can Feel So Scary

If you're experiencing frightening or panicked feelings due to visual disturbances while taking voriconazole, you're not alone — and there are reasons behind both the symptoms and your emotional response.

🧠 What Causes Visual Disturbances with Voriconazole?

  • Voriconazole crosses the blood–brain barrier and affects the central nervous system (CNS).

  • It interacts with retinal photoreceptors (especially rods), which may explain:

    • Lights seeming too bright or flickering.

    • Halos, flashes, or color distortions.

    • Visual “trails” following movement.

  • Although not fully understood, it may involve:

    • Temporary interference with visual signal processing in the brain and retina.

    • Altered neurotransmitter activity or enhanced retinal light sensitivity.

⏱️ When Do These Disturbances Happen and How Long Do They Last?

  • Onset: Symptoms typically begin 30 minutes to 2 hours after a dose.

  • Duration: They usually last 2 to 6 hours, fading as the drug is processed.

  • Resolution: Most people find the effects wear off before the next dose.

  • Over time, even if you stay on the drug, your body often adapts, and the symptoms lessen or disappear entirely within a few days to weeks.

😰 Why Do They Feel So Scary?

  • The effects are sudden and intense, often catching people off guard.

  • Our brains rely on visual input for safety — when this gets disrupted, it can trigger anxiety or panic.

  • If you live with anxiety or take other medications, your brain may amplify the sense of threat, even though the effect is temporary.

  • Descriptions like “psychedelic” or “derealised” are common — which understandably causes distress.

🩺 What Can You Do?

  1. Talk to your medical team. They may:

    • Check voriconazole blood levels.

    • Reduce the dose or change timing.

    • Switch to an alternative antifungal if needed.

  2. Avoid driving at night or doing visually demanding tasks until things settle.

  3. If anxiety is a problem:

    • Try grounding techniques (e.g. breath control, sound orientation).

    • Ask your doctor whether temporary support (like anti-anxiety medication or CBT) might help.

  4. Some patients find taking voriconazole in the evening lets them sleep through the worst of it — but check this with your prescriber first.

🔔 When to Get Urgent Help

If symptoms last unusually long, worsen over time, or include confusion, agitation, or hallucinations, contact your healthcare provider. These may be signs of CNS toxicity, especially if blood levels are high.

by GAtherton

🧠 Why Some Medications Can't Be Prescribed by GPs

In the UK, the NHS uses a tiered prescribing system that sometimes prevents GPs from prescribing certain medications, even if those medicines are available elsewhere in the NHS.

Here’s a clear explanation of how and why this happens:

🔒 1. Shared Care or Specialist-Only Medications

Some medicines are designated as “specialist-only” or “shared care” treatments. This means:

  • GPs are not authorised to initiate them.

  • In some cases, they can continue a prescription once a specialist starts it — but only if a formal shared care agreement is in place.

Examples include:

  • Biologics for asthma, ABPA, or autoimmune disease

  • High-risk antifungals like voriconazole or posaconazole

  • Certain cancer, transplant, or hormone drugs

This system ensures that:

  • The medication is closely monitored by someone with specialist knowledge

  • Risks like interactions, side effects, and required blood tests are safely managed

📜 2. Local Prescribing Formularies

Each NHS Integrated Care Board (ICB) or local NHS Trust maintains a formulary — a list of medicines approved for use in that area.

  • If a medicine isn't on the local formulary, the GP may be unable to prescribe it, even if NICE (the National Institute for Health and Care Excellence) says it's effective.

  • These decisions are based on local budget priorities, agreements with hospitals, and clinical capacity.

💷 3. Cost Controls and Prior Approvals

Some medications are expensive or highly specialised, and require:

  • Prior approval by a funding panel

  • A hospital-based consultant to apply for and justify the treatment

GPs usually cannot access these approval pathways directly.

⚠️ 4. Liability and Risk

Even if a GP understands the condition, they may not have:

  • Access to monitoring protocols

  • Up-to-date knowledge of rare drug interactions or side effects

  • The ability to interpret complex blood results needed for safe prescribing

For legal and safety reasons, GPs must follow guidance from their local ICB or NHS England on what they can and can’t prescribe.

✅ What Patients Can Do

  • Ask the hospital team if the medication can be prescribed under shared care, and whether your GP has agreed to it.

  • Ask your GP to request guidance from the local medicines management team.

  • Request a hospital prescription if urgent — but note this often requires collection from hospital pharmacies.

by GAtherton

🩺 Why an Aspergillosis Patient May Need a Pain Clinic

Chronic Chest Pain

  • Some patients with CPA, especially those with lung scarring, cavitation, or aspergillomas, develop persistent chest wall pain.

  • This can be caused by:

    • Chronic inflammation or infection near the pleura (lining of the lungs)

    • Pressure or stretching from damaged lung tissue

    • Muscle strain from chronic coughing

  • A pain clinic can assess neuropathic pain and offer non-opioid or low-dose medication strategies.

2. Postural or Musculoskeletal Pain

  • Long-term breathing difficulties can change how patients sit, stand, or move, leading to:

    • Neck, shoulder, or back pain

    • Costochondritis (pain around rib joints)

  • Pain clinics often include physiotherapists and occupational therapists who can help correct posture and reduce strain.

3. Pain from Coughing or Flare-Ups

  • Recurrent coughing fits in ABPA or CPA can lead to:

    • Rib bruising or even fractures

    • Abdominal muscle pain

    • Headaches and facial pain from sinus pressure

  • Clinics can help identify safer ways to manage flare-ups, including breathing strategies and adjunct treatments.

4. Neuropathic Pain or Nerve Irritation

  • Invasive aspergillosis (or surgical interventions for aspergilloma) can affect surrounding nerves, leading to:

    • Burning, tingling, or sharp shooting pain

    • Pain unresponsive to simple analgesics

  • Pain specialists may use gabapentinoids, tricyclics, or even nerve blocks to reduce symptoms.

5. Avoiding Long-Term Opioid Use

  • Pain clinics can help avoid or reduce opioid dependence by offering:

    • Safer, evidence-based medication options

    • Capsaicin creams, lidocaine patches, or infusions

    • Psychological support for the emotional toll of chronic pain

6. Improving Quality of Life

  • Chronic pain can lead to fatigue, poor sleep, low mood, and reduced activity.

  • Pain clinics work holistically, often involving:

    • Clinical psychologists for CBT or ACT (pain-focused therapy)

    • Personalised pacing plans

    • Tools for managing flare-ups and regaining confidence

✅ Summary:

Pain is real and common in aspergillosis — but often under-recognised. A referral to a specialist pain clinic offers a structured, supportive, and multidisciplinary approach to relief.

Attending an NHS pain clinic can offer several important advantages for people living with aspergillosis-related pain, as well as other long-term or complex pain conditions. GPs often have limited tools, time, and prescribing freedom — but pain clinics bring together specialist teams and a much broader range of options.

✅ Advantages of Attending an NHS Pain Clinic

1. Multidisciplinary Care

Pain clinics usually involve:

  • Pain consultants (anaesthetists or neurologists)

  • Specialist nurses

  • Physiotherapists

  • Clinical psychologists
    This team approach helps tackle pain from multiple angles — physical, emotional, and functional.

2. Access to a Wider Range of Treatments

Pain clinics can offer things your GP usually can’t prescribe or organise, such as:

  • Topical capsaicin or lidocaine plasters

  • Nerve blocks or steroid injections

  • Low-dose ketamine or lidocaine infusions (in hospital setting)

  • Medications like duloxetine, amitriptyline, or low-dose opioids used carefully

  • Neuromodulation techniques (e.g. TENS, PENS, spinal cord stimulators in some cases)

3. Safer Use of Medication

Specialists understand how to balance benefits and risks of pain medications — including when to use opioids, and how to minimise side effects or dependence.
They can also help you taper safely if you've been on pain meds long-term.

4. Improved Quality of Life

Pain clinics often focus on function over cure — helping you:

  • Sleep better

  • Move more confidently

  • Reduce pain flare-ups

  • Return to work or hobbies

  • Break the cycle of stress, pain, and fatigue

5. Psychological Support (Optional, but Useful)

Chronic pain is exhausting — emotionally as well as physically. Pain clinics may offer:

  • CBT for pain

  • Mindfulness or ACT (Acceptance and Commitment Therapy)

  • Support with coping, pacing, and flare-up planning

This isn’t about “it’s all in your head” — it’s about helping your brain and body deal with ongoing pain more effectively.

6. Validation and Advocacy

Just being believed and supported by a pain specialist can be a huge relief. They can also:

  • Write to your GP with specialist recommendations

  • Support benefits applications or workplace adjustments

  • Help you navigate complex diagnoses like aspergillosis + fibromyalgia, or lung disease + neuropathic pain

📍 When Should You Ask for a Referral?

  • If pain is lasting more than 3 months

  • If it’s affecting your daily function or mental wellbeing

  • If you're relying on medications that aren’t working or cause side effects

  • If you want to explore non-drug options

by GAtherton

Do antifungals actually help with breathing in ABPA?

🔹 Sometimes, yes — but it depends on the person and the stage of the disease.

In ABPA (Allergic Bronchopulmonary Aspergillosis), the main problem is an allergic reaction to Aspergillus, rather than a full-blown infection. This reaction causes inflammation, mucus plugging, and sometimes long-term damage like bronchiectasis.

🧪 What do antifungals do?

Antifungal medicines like itraconazole or voriconazole don’t treat the allergy directly.
Instead, they reduce the amount of Aspergillus in your lungs, which helps:

  • Lower the allergic response (so less inflammation)

  • Reduce flare-ups

  • Sometimes reduce the need for steroids

  • May improve symptoms like wheezing, chest tightness, or mucus

But…

⚠️ They don’t work instantly

  • You may not feel a dramatic improvement in breathing straight away.

  • The effect builds over weeks or months.

  • If your symptoms are caused more by scarring or fixed airway damage (like bronchiectasis), antifungals may not reverse that — but they can still help prevent things getting worse.

📊 What does research say?

  • Studies show antifungals can reduce IgE levels, mucus plugging, and exacerbations in many people.

  • About 60–70% of patients feel some improvement in symptoms or lung function.

  • Some don’t respond — or get side effects and have to stop.

💬 So, in short:

Antifungals can help breathing for many people with ABPA, especially if inflammation and allergy are still active. But they’re not a guaranteed fix — and they work best as part of an overall plan, not on their own.

If someone’s unsure whether to start, it’s worth discussing a trial of antifungal treatment with their respiratory team, and seeing how symptoms, lung tests, and IgE levels respond over time.

by GAtherton

🌿 Tezepelumab (Tezspire) and ABPA: What You Need to Know

If you’ve been living with ABPA and find your symptoms keep coming back despite steroids and antifungal treatment, your consultant may suggest a biologic (monoclonal antibody). One of the newer options being offered to some patients in the UK is Tezepelumab, brand name Tezspire.

💡 What is Tezepelumab?

Tezepelumab is a biologic injection that targets a molecule called TSLP (thymic stromal lymphopoietin). TSLP is an early trigger in the chain reaction that leads to inflammation in the lungs. By blocking it, Tezepelumab can calm multiple allergic and eosinophilic pathways, which makes it different from most other biologics that only block one type of inflammation.

✅ Who Might Be Offered Tezepelumab?

Tezepelumab is approved by NICE for use in the NHS in people aged 12+ with severe asthma, especially those who:

  • Are on high-dose inhaled steroids and still struggling

  • Have had 3+ asthma flare-ups in the last year, or

  • Need to take regular oral steroids

If you have both ABPA and severe asthma, you might be offered Tezepelumab—even though it isn’t specifically licensed for ABPA.

🔍 How Does It Compare to Other Biologics?

Here’s a quick comparison:

Biologic Name Target NHS Use Needs High IgE or Eosinophils?
Omalizumab IgE Severe allergic asthma ✅ Yes – High IgE needed
Mepolizumab IL-5 Eosinophilic asthma ✅ Yes – High eosinophils needed
Benralizumab IL-5 receptor Eosinophilic asthma ✅ Yes
Dupilumab IL-4/13 Allergic asthma ❌ No, but usually allergy-type
Tezepelumab TSLP (upstream) Severe asthma (NICE-approved) ❌ No – works across all types

🧠 Why this matters: If your IgE or eosinophil levels aren’t high, Tezepelumab may still work for you—even when other biologics aren't suitable.

💷 Is Tezepelumab Expensive?

Yes—but it's funded on the NHS for patients who meet NICE criteria.

  • List price: ~£1,265 per injection (monthly)

  • NHS pays less through a confidential discount agreement

  • It’s not necessarily cheaper than other biologics, but it offers wider eligibility and broad activity

⚖️ Is It Better Than Other Biologics?

It depends. Some patients respond well to older biologics like omalizumab or mepolizumab, especially if their ABPA overlaps with allergy or eosinophilic asthma. But Tezepelumab may be a better fit if:

  • You don’t qualify for the others (e.g. your IgE is too low)

  • You’ve tried other biologics and they didn’t help enough

  • Your ABPA overlaps with hard-to-control asthma

While Tezepelumab isn’t licensed specifically for ABPA, its upstream targeting may help reduce flare-ups in those with overlapping conditions.

💉 Side Effects

Most people tolerate Tezepelumab well. Possible side effects include:

  • Injection site reactions (redness, swelling)

  • Headache or sore throat

  • Allergic reaction (rare)

It's given by subcutaneous injection once a month, often at hospital initially, but home administration may be an option later on.

👩‍⚕️ What to Ask Your Consultant

  • Why are you recommending this biologic for me?

  • Will it help with both my ABPA and asthma?

  • How soon should I expect results?

  • Can I stop steroids if this works?

Keeping a symptom diary and reporting back is really useful to your team.

🧾 Summary

Question Tezepelumab (Tezspire) Answer
Licensed for ABPA? ❌ No, but used off-label when asthma overlaps
Approved for NHS use? ✅ Yes – via NICE for severe asthma
IgE or eosinophils needed? ❌ No
Dose/frequency Monthly injection
Broad anti-inflammatory effect? ✅ Yes – acts early in the pathway

Tezepelumab is opening new doors for people with ABPA and severe asthma who’ve struggled with flare-ups, steroid side effects, or biologics that didn’t work. It’s not for everyone, but it’s worth a conversation with your specialist.

by GAtherton

🧬 Biologic Treatments for ABPA (Allergic Bronchopulmonary Aspergillosis)

Many people with ABPA who continue to experience flare-ups despite steroids and antifungals are now being offered biological therapies—also known as monoclonal antibodies.

These treatments target specific parts of the immune system involved in allergic inflammation. They're often used when:

  • Steroids are needed frequently or at high doses

  • Antifungals alone aren’t enough

  • ABPA keeps recurring and affecting quality of life

💉 Biologics Currently Used in ABPA

The following biologics are being used in the UK, particularly in specialist centres and often in patients with ABPA plus severe asthma or eosinophilic disease:

Biologic Name Target Brand Name Notes
Omalizumab IgE Xolair Most commonly used; good for high IgE and allergic asthma
Mepolizumab IL-5 Nucala For eosinophilic inflammation; steroid-sparing
Benralizumab IL-5 receptor (IL-5Rα) Fasenra Rapidly reduces eosinophils; monthly or 8-weekly injection
Dupilumab IL-4 and IL-13 Dupixent Used in allergic-type asthma and some ABPA patients
Reslizumab IL-5 Cinqaero IV infusion; less commonly used in ABPA
Tezepelumab TSLP (upstream cytokine) Tezspire Newest option; blocks multiple inflammatory pathways; doesn’t require high IgE or eosinophils

👉 Note: No biologic is officially licensed specifically for ABPA, but many are used off-label in patients with overlapping severe asthma or allergic disease.

✅ What Do Patients Say?

Many people treated with biologics report:

  • Fewer flare-ups or “chest infections”

  • Less need for oral steroids

  • Clearer breathing, less coughing, and better energy

Not everyone responds, but many see significant improvement in control and quality of life.

⚠️ Side Effects

Biologics are generally well-tolerated. Possible side effects include:

  • Mild injection site reactions (redness, swelling)

  • Headaches or fatigue

  • Allergic reactions (rare)

They’re usually given every 2–8 weeks as an injection under the skin, sometimes in hospital at first and then possibly at home.

🩺 What to Ask Your Consultant

  • Why have you chosen this biologic for me?

  • Will it help my asthma as well as ABPA?

  • How soon will I know if it’s working?

  • Will I still need antifungals or steroids?

  • Are there any alternatives if this one doesn’t work?

📌 Summary

Key Point Biologics in ABPA
Used when Steroids aren’t enough or cause side effects
Most used Omalizumab, Mepolizumab, Tezepelumab
Goals Reduce flares, improve breathing, lower steroid use
Licensed for ABPA? ❌ No – but used off-label in many UK centres
NHS funding? ✅ Yes – when criteria for severe asthma are met

by GAtherton

COVID-19 Associated Pulmonary Aspergillosis (CAPA) for Expert Patients and non-Specialist Clinicians

Expert Information for Patients, GPs, and Specialist Nurses

🔎 What Is CAPA?

CAPA is a form of invasive pulmonary aspergillosis (IPA) that develops in patients with severe COVID-19, particularly those in intensive care units (ICU) with acute respiratory distress syndrome (ARDS). It is an opportunistic fungal infection caused by Aspergillus fumigatus, occurring without traditional risk factors such as neutropenia.

CAPA is part of the broader group of IAPA (Influenza-Associated Pulmonary Aspergillosis) and VAPA (Viral-Associated Pulmonary Aspergillosis).

🧬 Pathophysiology

  • Severe viral pneumonia (COVID-19) damages the airway epithelium.

  • Inhaled Aspergillus spores invade damaged lung tissue.

  • Corticosteroids (e.g. dexamethasone), immunomodulators (e.g. tocilizumab), and prolonged ventilation increase susceptibility.

👥 Who Is at Risk?

Primarily affects patients with:

  • Severe COVID-19 pneumonia, especially those with:

    • ICU admission

    • Mechanical ventilation

    • ARDS

  • Corticosteroid therapy or IL-6 inhibitors (e.g. tocilizumab)

  • Underlying lung disease (COPD, asthma)

  • Diabetes mellitus

📍 CAPA may occur even in immunocompetent individuals due to local lung immune disruption.

⚠️ Clinical Features

Often non-specific and difficult to distinguish from worsening COVID-19:

  • Persistent or worsening respiratory failure

  • New pulmonary infiltrates on imaging

  • Fever despite antibacterial therapy

  • Haemoptysis or pleuritic chest pain (less common)

  • Increased oxygen or ventilatory support requirement

🧪 Diagnosis

CAPA is challenging to diagnose and relies on clinical suspicion, radiology, and mycological evidence.

Diagnostic Tools:

  • CT Chest:

    • Nodules, cavitations, halo sign (often non-specific in COVID)

  • Bronchoscopy with BAL:

    • Galactomannan (BAL GM ≥1.0 = probable CAPA)

    • Culture and PCR for Aspergillus

  • Serum Galactomannan or β-D-glucan:

    • May be positive but less sensitive than BAL

  • Histopathology (rarely obtained due to ICU setting)

Diagnostic Categories (ECMM/ISHAM 2020):

  • Proven: histology showing fungal invasion

  • Probable: radiology + mycology from BAL

  • Possible: suggestive clinical picture + limited microbiology

💊 Treatment

First-Line:

  • Voriconazole (IV or oral)

  • Isavuconazole (alternative with fewer side effects)

  • Consider liposomal amphotericin B if azole resistance or intolerance

Additional Considerations:

  • Therapeutic drug monitoring (TDM) required for voriconazole

  • Duration: typically 6–12 weeks depending on response and immune status

  • Minimise immunosuppression where possible

Empirical antifungal therapy may be started in ICU when suspicion is high, even before full confirmation.

🧾 Monitoring

  • Respiratory function

  • Repeat imaging to assess progression or resolution

  • Serum galactomannan

  • Liver function, renal function, and drug levels

  • Screen for drug interactions (especially with azoles)

📚 More Information

  • CAPA is a recently recognised entity, requiring close coordination between ICU, respiratory, and infectious disease teams.

  • Early antifungal treatment improves outcomes, but diagnosis is often delayed due to overlapping features with COVID-19 pneumonia.

  • Resources: ECMM/ISHAM CAPA definitions, aspergillosis.org

by GAtherton

 I sat outside in the spring sunshine for 45 minutes and now I have a rash

Question: "I sat outside in the spring sunshine for 45 minutes in a t-shirt, trousers and a hat. I have now got a rash on both hands and arms. Is this due to me taking voriconazole? Any ideas what to do?"

Answer: The sun is a rare and welcome guest in the UK! But yes, the rash you're describing very likely is due to voriconazole. Here’s what you need to know and what you can do about it:

☀️ Why the Rash Happened

Voriconazole is well known to cause photosensitivity reactions — even in mild sunlight and after short exposure. This happens because:

  • The drug causes phototoxicity, meaning it reacts with UV-A and UV-B rays, damaging the skin directly.

  • These reactions can be immediate (sunburn-like rash, redness, stinging) or delayed (itchy, scaly rash days later).

  • It happens even in places with relatively low sun exposure — like Scotland/Northern Ireland/Northern England.

🔍 What the Rash Looks Like

Typical features of voriconazole-induced photosensitivity:

  • Redness, itching, or stinging in sun-exposed areas (hands, arms, neck, face)

  • Often clearly demarcated where clothes stop

  • May blister or peel in more severe cases

  • Can evolve into chronic skin damage with repeated exposure

✅ What to Do Now

1. Get out of the sun and monitor the rash

  • Stay in the shade or indoors while the rash settles.

  • Avoid more sun over the next few days.

2. Soothing relief

  • Apply a cool compress or unscented moisturiser (e.g. E45, Cetraben).

  • A mild topical steroid (like hydrocortisone 1%) may help if the rash is itchy — ask your GP or pharmacist.

  • Antihistamines (e.g. loratadine or cetirizine) can reduce itching.

3. Contact your GP or specialist

  • Let them know this happened — even if it settles.

  • It may influence whether you continue voriconazole or switch to another antifungal (like posaconazole, which has less photosensitivity risk).

☂️ How to Protect Yourself in Future

If you stay on voriconazole:

  • Always wear long sleeves and a wide-brimmed hat when outdoors — even in cloudy weather.

  • Use a high-SPF sunscreen (SPF 50+) with UVA and UVB protection — but apply 30 minutes before sun exposure and reapply every 2 hours.

  • Avoid sun between 11am–3pm if possible.

  • Some people need to avoid sunlight through windows or in cars, especially on longer journeys.

🚨 When to Seek Urgent Help

Call your GP or 111 if:

  • The rash is blistering, painful, or spreading

  • You feel unwell (e.g. fever, chills)

  • You develop ulcers or notice skin peeling

You’re definitely not alone — this is a very common side effect of voriconazole.

by GAtherton

🍷 Aspergillosis and Alcohol: What You Need to Know

If you're being treated for Aspergillosis — whether ABPA (Allergic Bronchopulmonary Aspergillosis), CPA (Chronic Pulmonary Aspergillosis), or invasive disease — you're likely taking medications that could interact with alcohol. It's natural to wonder: "Is it safe to drink?"

The short answer is: It depends on what you're taking. Some medications interact badly with alcohol, while others are safer in moderation. This guide will help you make informed decisions and avoid risks.

⚠️ Why Alcohol Can Be Risky with Aspergillosis Medications

Many of the medications used to treat or manage aspergillosis:

  • Are processed in the liver, just like alcohol.

  • Can cause side effects that alcohol may worsen (nausea, dizziness, confusion).

  • May become less effective if alcohol interferes with how they’re absorbed or metabolised.

🚫 Medications Where Alcohol Should Be Avoided or Used with Caution

Medication Used For Alcohol Guidance Why It Matters
Voriconazole First-line antifungal for CPA & invasive disease ❌ Avoid Increases risk of liver damage, visual and neurological side effects. Can be dangerous.
Itraconazole ABPA, CPA ⚠️ Caution / Avoid May strain the liver, cause stomach upset, and interact with alcohol metabolism.
Posaconazole Antifungal prophylaxis or salvage therapy ⚠️ Caution Alcohol can affect absorption and add to liver burden.
Amphotericin B (IV) Severe or hospitalised cases ✅ Generally OK Not processed by the liver, but alcohol may worsen nausea and kidney strain.
Caspofungin Invasive infections (alternative) ⚠️ Caution Can raise liver enzymes — best to limit alcohol.
Prednisolone ABPA flares, inflammation ⚠️ Limit Increases stomach ulcer risk, mood swings, blood sugar changes — alcohol adds to these.
Methotrexate (rare cases) Used if ABPA overlaps with autoimmune disease ❌ Strictly avoid High risk of liver toxicity — alcohol is contraindicated.
Opioids or codeine For cough or pain relief ❌ Avoid Strong risk of drowsiness, slowed breathing, and overdose when combined with alcohol.
Azithromycin (used in bronchiectasis or NTM) Anti-inflammatory/anti-infective ⚠️ Caution May increase risk of heart rhythm changes if mixed with alcohol.
Biologics (Mepolizumab, Benralizumab, Omalizumab) Severe asthma, ABPA ✅ Safe in moderation No known alcohol interaction. Keep to small amounts.

✅ When Alcohol Might Be Safe

You may still enjoy an occasional small drink if:

  • You're not on medications with serious liver or central nervous system risks.

  • Your liver function is normal (check with your team).

  • You take your medication as prescribed, and only drink in moderation.

🧠 Tips for Safer Drinking (If Allowed)

  • Stick to low-risk drinking guidelines (no more than 1 unit/day).

  • Avoid drinking when you’re unwell, stressed, or on multiple medications.

  • Never use alcohol to help with sleep, anxiety, or fatigue.

  • Take medication with food if also drinking alcohol.

  • Always check with your consultant or pharmacist if unsure.

🎯 Bottom Line

"If you’re taking antifungal medications or steroids for aspergillosis, alcohol can add risks that aren’t always obvious. Check your drug list, listen to your body, and when in doubt — ask your team."

Some medications, like voriconazole and methotrexate, really don’t mix safely with alcohol. Others, like prednisolone or biologics, may allow for small, occasional drinks — but still require caution.

by GAtherton