Allergic bronchopulmonary aspergillosis (ABPA) is an eosinophilic pulmonary disorder that occurs in response to allergic sensitization to antigens from Aspergillus species fungi. Asthmatic phenotype, often accompanied with production of brownish plugs of mucus. Consider in cases of bronchial asthma refractory to usual therapy.
- Prominent peripheral eosinophilia and elevated circulating levels of IgE (>417 IU/mL).
- Diagnosis of ABPA is established by
- Sensitivity to Aspergillus antigens by skin test reactivity.
- Positive serum precipitins for Aspergillus.
- Direct measurement of circulating specific IgG and IgE to Aspergillus.
- Chest Xray-PA: Central bronchiectasis is a classic finding. Patchy infiltrates and mucus impaction.
Lab Tests (Panel)
- ABPA-Mini (SRL)
- Specific IgE Aspergillus fumigatus
- Specific IgG Aspergillus fumigatus
- ABPA-Panel (SRL)
- Total IgE level
- Specific IgE Aspergillus fumigatus
- Specific IgG Aspergillus fumigatus
- ABPA-Screen (SRL)
- Total IgE level
- Specific IgE Aspergillus fumigatus
Treatment
- Glucocorticoids: should be tapered over 3–6 months, and their use must be balanced against the risks of prolonged steroid therapy.
- Antifungal agents such as fluconazole and voriconazole given over a 4-month course reduce the antigenic stimulus in ABPA and may therefore modulate disease activity in selected patients.
- The use of monoclonal antibody against IgE (omalizumab)
has been described in treating severe ABPA, particularly in individuals with ABPA as a complication of cystic fibrosis.