Allergic bronchopulmonary aspergillosis is a hypersensitivity reaction to bronchial colonisation byAspergillus fumigatus mould, typically affecting patients with asthma or cystic fibrosis.
Exposure of atopic people to fungal spore elements results in the formation of immunoglobulin E and immunoglobulin G antibodies.
Presents as asthma complicated by bronchial obstruction, fever, malaise, expectoration of brownish mucus plugs, peripheral blood eosinophilia, and haemoptysis.
Treatment involves environmental control measures, corticosteroids, and azole antifungals.
Early detection and treatment can prevent the development of bronchiectasis or pulmonary fibrosis that otherwise occurs in the later stages of the disease.
Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to mould that occurs when bronchi become colonised by Aspergillus fumigatus in an otherwise immunocompetent person. Patients usually have a prior diagnosis of atopy, asthma, or cystic fibrosis. Exposure of an atopic person to fungal elements results in the formation of IgE and IgG antibodies. Typically, the patient presents with bronchial obstruction, airway inflammation, and mucoid impaction that can lead to bronchiectasis, fibrosis, and respiratory compromise.
History and exam
Key diagnostic factors
- history of asthma
- history of cystic fibrosis (CF)
- teenagers and young adults with CF
- history of atopy
- mucus plugs
Other diagnostic factors
- pleuritic chest pain
- finger clubbing
- weight loss
- cystic fibrosis
- HLA-DR2- and HLA-DR5-positive
- IL-10 promoter polymorphisms
- surfactant protein polymorphisms
- CFTR gene
1st investigations to order
- skin test for Aspergillus fumigatus sensitivity
- serum total IgE
- FBC with peripheral blood eosinophil count
- chest x-ray
- CT chest
- Aspergillus-specific IgE
Investigations to consider
- Aspergillus-specific IgG
- serum precipitating antibodies to Aspergillus fumigatus
- sputum culture and microscopy
- HLA antigens
stage 1: acute
stage 2: remission
stage 3: exacerbation
stage 4: corticosteroid-dependent asthma
stage 5: end-stage fibrosis
Cristine Radojicic, MD
Department of Pulmonary, Allergy and Critical Care
CR is on the Advisory Board for CSL Behring and the Speakers Bureau for BioCryst.
Martin Schöni, MD
Department of Pediatrics
University of Bern
MS declares that he has no competing interests.
Jordan Fink, MD
Professor of Pediatrics
Medical College of Wisconsin
JF is an author of a number of references cited in this topic.
- Asthma exacerbation
- Non-ABPA infectious exacerbation of cystic fibrosis
- Chronic eosinophilic pneumonia (CEP)
- ABPA and aspergillus lung infection, cystic fibrosis patients
- Practice guidelines for the diagnosis and management of aspergillosis
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