Allergic bronchopulmonary aspergillosis

Hypersensitivity reaction to Aspergillus fumigatus mould that has colonised bronchi of patients with asthma or cystic fibrosis.

Exposure of atopic people to fungal spore elements results in the formation of IgE and IgG 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 itraconazole.

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.[1]Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 2002;110:685-692. http://www.jacionline.org/article/PIIS009167490201415X/fulltext http://www.ncbi.nlm.nih.gov/pubmed/12417875?tool=bestpractice.com [2]Mahdavinia M, Grammer LC. Management of allergic bronchopulmonary aspergillosis: a review and update. Ther Adv Respir Dis. 2012;6:173-187. http://www.ncbi.nlm.nih.gov/pubmed/22547692?tool=bestpractice.com Patients usually have a prior diagnosis of atopy, asthma, or cystic fibrosis.[3]Zander DS. Allergic bronchopulmonary aspergillosis: an overview. Arch Pathol Lab Med. 2005;129:924-928. http://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282005%29129%5B924%3AABAAO%5D2.0.CO%3B2 http://www.ncbi.nlm.nih.gov/pubmed/15974818?tool=bestpractice.com Exposure of an atopic person to fungal elements results in the formation of IgE and IgG antibodies.[4]Tillie-Leblond I, Tonnel AB. Allergic bronchopulmonary aspergillosis. Allergy. 2005;60:1004-1013. http://onlinelibrary.wiley.com/doi/10.1111/j.1398-9995.2005.00887.x/full http://www.ncbi.nlm.nih.gov/pubmed/15969680?tool=bestpractice.com Typically, the patient presents with bronchial obstruction, airway inflammation, and mucoid impaction that can lead to bronchiectasis, fibrosis, and respiratory compromise.