Allergic Bronchopulmonary Aspergillosis

Ricketti, Anthony J.; Greenberger, Paul A.; Mintzer, Richard A.; Patterson, Roy

doi:10.1378/chest.86.5.773

Cited by 43 publications

(16 citation statements)

References 31 publications

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“…This disease may represent one of the extreme manifestations of mould allergy. The definition of ABPA is shown in table 2 [126,127]. Genetic influences are also important in this area and, for example, some patients with ABPA have a defect in surfactant A2 [128]; human leukocyte antigen (HLA) restriction in ABPA (DR2 and DR5) is also more frequent in asthmatics who have Aspergillus allergy, but the presence of HLA DQ2 (especially DQB1*0201) provided protection from ABPA [123].…”

Section: Allergic Bronchopulmonary Aspergillosis/ Mycosismentioning

confidence: 99%

The link between fungi and severe asthma: a summary of the evidence

Denning

O’Driscoll²,

Hogaboam³

et al. 2006

European Respiratory Journal

723

631

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There is current evidence to demonstrate a close association between fungal sensitisation and asthma severity. Whether such an association is causal remains to be confirmed, but this is explored by means of a detailed literature review. There is evidence from two randomised controlled trials that, in the example of allergic bronchopulmonary aspergillosis (ABPA), treatment with systemic antifungal therapy can offer a therapeutic benefit to ,60% of patients. ABPA is only diagnosed if a combination of clinical and immunological criteria is achieved. It is not known whether such cases are a discrete clinical entity or part of a spectrum of the pulmonary allergic response to fungi or fungal products.This paper describes the epidemiological evidence that associates severity of asthma with fungi and discusses possible pathogenetic mechanisms. Many airborne fungi are involved, including species of Alternaria, Aspergillus, Cladosporium and Penicillium, and exposure may be indoors, outdoors or both. The potential for a therapeutic role of antifungal agents for patients with severe asthma and fungal sensitisation is also explored.Not only are many patients with severe asthma desperately disabled by their disease, but, in the UK alone, asthma accounts for 1,500 deaths per yr. The healthcare costs of these patients are enormous and any treatment option merits close scrutiny. Within this report, the case for the consideration of a new term related to this association is put forward. The current authors propose the term ''severe asthma with fungal sensitisation''. However, it is recognised that enhanced and precise definition of fungal sensitisation will require improvements in diagnostic testing.

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Section: Allergic Bronchopulmonary Aspergillosis/ Mycosismentioning

confidence: 99%

The link between fungi and severe asthma: a summary of the evidence

Denning

O’Driscoll²,

Hogaboam³

et al. 2006

European Respiratory Journal

723

631

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“…Radiographically, chronic airway invasive aspergillosis starts as a focus of consolidation (usually in the upper lobes), which progresses with time to cavitation, and subsequent aspergilloma formation with associated adjacent pleural thick- and (e) fibrotic lung disease (extensive changes on the chest radiograph, which are irreversible). In the early stages of the disease (stages 1-3) the disease is still potentially reversible, but in the later stages (stages 4-5) irreversible parenchymal changes have occurred in the form of central bronchiectasis and fibrosis [75]. The terminology "ABPA-CB" is used when central bronchiectasis is present and "ABPA-Serologic" when it is not [71], but this presupposes that all patients with suspected ABPA undergo an HRCT examination.…”

Section: Ii) Chronic Airway Invasive Aspergillosismentioning

confidence: 99%

Aspergillus in the lung: diverse and coincident forms

Buckingham

Hansell

2003

Eur Radiol

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Pulmonary disease caused by the fungus Aspergillus has traditionally been regarded as belonging to one of the following, apparently distinct, entities: saprophytic aspergilloma; allergic bronchopulmonary aspergillosis (ABPA); and invasive aspergillosis (IPA); which may be further categorised as angioinvasive, acute or chronic airway invasive) [1]. It is not always obvious that there is overlap between these entities, and that in any given patient more than one Aspergillus-related pathological process can co-exist [2]. The aim of this article is to review the clinical and imaging features of the main categories of Aspergillus-related pulmonary disease and, in particular, to highlight the overlap between them.

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“…In patients with idiopathic eosinophilic pneumonia (IEP), bronchoalveolar lavage (BAL) shows an increase of the total cell count, with a marked increase of eosinophils; the percentage of macrophages is consequently reduced, whereas lymphocytes do not show significant changes [1]. Eosinophilic lung disorders include Loeffler's syndrome [2], Aspergillus infection [3], eosinophilic pneumonia in bronchial asthma [4], drug-induced pneumonia [5], tropical eosinophilia [6], chronic eosinophilic pneumonia [7], acute eosinophilic pneumonia with respiratory failure [8], Churg-Strauss syndrome [9], and idiopathic eosinophilic pneumonia [10].…”

mentioning

confidence: 99%

Activated and memory alveolar T-lymphocytes in idiopathic eosinophilic pneumonia

Albera

Ghio²,

Solidoro³

et al. 1995

Eur Respir J

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A Ac ct ti iv va at te ed d a an nd d m me em mo or ry y a al lv ve eo ol la ar r T T--l ly ym mp ph ho oc cy yt te es s i in n i id di io op pa at th hi ic ce eo os si in no op ph hi il li ic c p pn ne eu um mo on ni ia a In IEP, total and differential cell counts showed a mild alveolitis with an increase of eosinophil percentage and number; the alveolar lymphocyte count was also increased. In BAL, the total number both of CD4+ and CD8+ lymphocytes was significantly raised; CD4+ cells expressed early (CD25) activation antigens. The analysis of CD45R0, CD45RA and CD62L coexpression in IEP patients, when compared to healthy controls, revealed an accumulation of alveolar CD4+ cells showing phenotypic repertoire usually expressed by memory T-cells (CD45R0+, CD45RA-, CD62L-). CD8+ alveolar lymphocytes did not show any significant increase of activation antigen coexpression. Circulating lymphocytes were not significantly increased and showed only a significantly higher CD25 expression.These data suggest that a pivotal role is played by activated and memory CD4+ alveolar lymphocytes in IEP patients.

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Allergic Bronchopulmonary Aspergillosis

Cited by 43 publications

References 31 publications

The link between fungi and severe asthma: a summary of the evidence

The link between fungi and severe asthma: a summary of the evidence

Aspergillus in the lung: diverse and coincident forms

Activated and memory alveolar T-lymphocytes in idiopathic eosinophilic pneumonia

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