Developments in the diagnosis and treatment of allergic bronchopulmonary aspergillosis

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a complex pulmonary disorder characterized by recurrent episodes of wheezing, fleeting pulmonary opacities and bronchiectasis. It is the most prevalent of the Aspergillus disorders with an estimated five million cases worldwide. Despite six decades of research, the pathogenesis, diagnosis and treatment of this condition remains controversial. The International Society for Human and Animal Mycology has formed a working group to resolve the controversies around this entity. In the year 2013, this group had proposed new criteria for diagnosis and staging, and suggested a treatment protocol for the management of this disorder. Since then, several pieces of new evidence have been published in the investigation and therapeutics of this condition. Areas covered: A non-systematic review of the available literature was performed. We summarize the current evidence in the evaluation and treatment of this enigmatic disorder. We suggest modifications to the existing criteria and propose a new scoring system for the diagnosis of ABPA. Expert commentary: All patients with asthma and cystic fibrosis should routinely be screened for ABPA using A. fumigatus-specific IgE levels. Glucocorticoids should be used as the first-line of therapy in ABPA, and itraconazole reserved in those with recurrent exacerbations and glucocorticoid-dependent disease.

Role of <b><i>Aspergillus fumigatus-</i></b>Specific IgE in the Diagnosis of Allergic Bronchopulmonary Aspergillosis

“…It is a type I and type III hypersensitivity-mediated allergic reaction to pulmonary parasitic Aspergillus [10], with the main clinical manifestations being shortness of breath (or hardly controlled asthma), transient lung shadows, and recurrent bronchiectasis, sometimes accompanied by fever, fatigue, weight loss, or hemoptysis [7]. The hyphae formed by Aspergillus conidia release various inflammatory mediators, which further induce a Th2 immune response and result in inflammatory responses via the secretion of interleukin (IL)-4, IL-5, IL-13 and other cytokines, and the stimulation of inflammatory cells such as eosinophils [11].…”

“…In 2013, the recommended diagnostic guidelines for ABPA were put forward by the ABPA expert group of the International Society for Human and Animal Mycology (ISHAM). In December 2016, Agarwal et al [6, 7] revised the diagnostic criteria and proposed a new scoring system for the diagnosis of ABPA. It suggests that all patients with asthma should undergo screening for ABPA with A. fumigatus- specific IgE (sIgE).…”

A new IgE Western blot identifies Aspergillus fumigatus sensitization and may discriminate allergic bronchopulmonary aspergillosis

“…To the Editor, Asthmatic, cystic fibrosis (CF), chronic obstructive pulmonary disease and posttuberculous fibrocavitary disease patients are burdened with various Aspergillus-related diseases (ARD), with Aspergillus fumigatus (Af) as the most prevalent culprit. 1,2 Allergic bronchopulmonary aspergillosis (ABPA) is a severe ARD, with an estimated prevalence of 2.5% among asthmatic patients and up to 15% among patients with CF. 3 The detection of Af-specific IgE (Af-IgE) through serological or skin tests defines Af sensitization, a common finding in patients with asthma or CF.…”

A randomised trial of vitamin D in acute‐stage allergic bronchopulmonary aspergillosis complicating asthma

“…Allergic bronchopulmonary aspergillosis (ABPA) is an immunological disorder caused by hypersensitivity reactions against Aspergillus fumigatus . It usually complicates the course of individuals with bronchial asthma or cystic fibrosis (CF).…”