Treating allergic bronchopulmonary aspergillosis: the way forward

Moss, Richard B.

doi:10.1183/13993003.01816-2015

Cited by 13 publications

(11 citation statements)

References 34 publications

(33 reference statements)

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“…Bronchial colonisation with A. fumigatus certainly drives the development of allergic forms of aspergillosis [ 76 , 114 ]. Aspergillus hypersensitisation is characterised by a raised immunoglobulin E response to Aspergillus allergens without clinical symptoms [ 76 , 107 ].…”

Section: Aspergillus Fumigatus Is the Predominamentioning

confidence: 99%

Factoring in the Complexity of the Cystic Fibrosis Lung to Understand Aspergillus fumigatus and Pseudomonas aeruginosa Interactions

2020

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Pseudomonas aeruginosa has long been established as the most prevalent respiratory pathogen in Cystic Fibrosis (CF) patients, with opportunistic infection causing profound morbidity and mortality. Recently, Aspergillus fumigatus has also been recognised as a key contributor to CF lung deterioration, being consistently associated with decreased lung function and worsened prognosis in these patients. As clinical evidence for the common occurrence of combined infection with these two pathogens increases, research into the mechanism and consequences of their interaction is becoming more relevant. Clinical evidence suggests a synergistic effect of combined infection, which translates into a poorer prognosis for the patients. In vitro results from the laboratory have identified a variety of possible synergistic and antagonistic interactions between A. fumigatus and P. aeruginosa. Here, we present a comprehensive overview of the complex environment of the CF lung and discuss how it needs to be considered to determine the exact molecular interactions that A. fumigatus and P. aeruginosa undergo during combined infection and their effects on the host.

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Section: Aspergillus Fumigatus Is the Predominamentioning

confidence: 99%

Factoring in the Complexity of the Cystic Fibrosis Lung to Understand Aspergillus fumigatus and Pseudomonas aeruginosa Interactions

2020

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“…[95] However, unlike ABPA, chronic infection with A. fumigatus does not adversely affect pulmonary function by itself. [11]…”

Section: Natural Course and Outcomementioning

confidence: 99%

“…[1080] Fortunately, a number of trials are currently ongoing to address key questions in the management of ABPA. [11] One randomized trial is comparing the efficacy of oral glucocorticoids to oral itraconazole monotherapy (NCT01321827), another comparing oral glucocorticoids to oral voriconazole (NCT01621321), and a third one comparing oral glucocorticoids to combined oral glucocorticoid–itraconazole therapy (NCT0244009). Moreover, as steroid therapy is often complicated by systemic toxicity,[96] alternative treatment options for ABPA are being actively explored.…”

Section: Future Directionsmentioning

confidence: 99%

“…Moreover, as steroid therapy is often complicated by systemic toxicity,[96] alternative treatment options for ABPA are being actively explored. [11] Omalizumab appears to be an effective steroid-sparing drug that reduces the frequency of relapse and exacerbations in patients with ABPA. [8586878889] More evidence from larger randomized clinical trials will further substantiate its role in the management of ABPA.…”

Section: Future Directionsmentioning

confidence: 99%

“…[10] Over the past one decade, newer therapies for ABPA in patients with CF have been developed and shown to be effective. [11] In this review, we present the epidemiology, clinical features, diagnostic evaluation, and management of ABPA in CF patients in the light of the currently available evidence.…”

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confidence: 99%

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Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

2017

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Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that often occurs in patients with asthma or cystic fibrosis (CF) and is characterized by a hypersensitivity response to the allergens of the fungus Aspergillus fumigatus. In patients with CF, growth of A. fumigatus hyphae within the bronchial lumen triggers an immunoglobulin E (IgE)-mediated hypersensitivity response that results in airway inflammation, bronchospasm, and bronchiectasis. In most published studies, the prevalence of ABPA is about 8.9% in patients with CF. Since the clinical features of this condition overlap significantly with that of CF, ABPA is challenging to diagnose and remains underdiagnosed in many patients. Diagnosis of ABPA in CF patients should be sought in those with evidence of clinical and radiologic deterioration that is not attributable to another etiology, a markedly elevated total serum IgE level (while off steroid therapy) and evidence of A. fumigatus sensitization. Management of ABPA involves the use of systemic steroids to reduce inflammation and modulate the immune response. In patients who do not respond to steroids or cannot tolerate them, antifungal agents should be used to reduce the burden of A. fumigatus allergens. Recent studies suggest that omalizumab may be an effective option to reduce the frequency of ABPA exacerbations in patients with CF. Further randomized controlled trials are needed to better establish the efficacy of omalizumab in managing patients with CF and ABPA.

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