Overview
Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder characterized by recurrent wheezing, cough, and pulmonary infiltrates due to an exaggerated immune response to Aspergillus fumigatus in patients with asthma or cystic fibrosis 1.Diagnosis
Key Diagnostic Criteria: Positive serum IgE antibodies specific to A. fumigatus, characteristic clinical symptoms, and often radiological findings 1.
Recommended Tests: Serum specific IgE levels, skin prick test or intradermal test, and high-resolution computed tomography (HRCT) chest imaging 15.
Grading: Radiological classification based on central bronchiectasis (CB) and other radiological features (ORF), with newer emphasis on high-attenuation mucus (HAM) as a marker of inflammatory activity 4.Management
First-Line Treatments: Corticosteroids (typically oral or inhaled) to control inflammation and reduce exacerbations 1.
Adjunctive Treatments: Itraconazole or other antifungal agents to manage fungal load, particularly in persistent or severe cases 1.
Emerging Therapies: Omalizumab shows promise in reducing exacerbations and oral corticosteroid use in treatment-refractory cases 2.Special Populations
Pediatrics: Specific dosing and monitoring guidelines are not detailed in provided abstracts; individualized management based on severity is recommended 1.
Comorbidities: Management considerations for patients with cystic fibrosis or asthma should focus on integrated care addressing both conditions 14.Key Recommendations
Screen and diagnose ABPA using serum specific IgE antibodies, clinical symptoms, and radiological features including HAM for assessing disease activity (Evidence: Strong 14).
Initiate corticosteroid therapy for controlling inflammation and exacerbations in ABPA management (Evidence: Strong 1).
Consider adjunctive antifungal therapy, particularly itraconazole, for persistent or severe ABPA cases (Evidence: Moderate 1).
Evaluate omalizumab as a therapeutic option for patients with refractory ABPA to reduce exacerbations and corticosteroid dependency (Evidence: Moderate 2).
Monitor and manage ABPA in special populations like pediatric patients with tailored approaches based on disease severity (Evidence: Expert opinion 1).References
1 Agarwal R, Sehgal IS, Muthu V, Denning DW, Chakrabarti A, Soundappan K et al.. Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses. The European respiratory journal 2024. link
2 Jin M, Douglass JA, Elborn JS, Agarwal R, Calhoun WJ, Lazarewicz S et al.. Omalizumab in Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Meta-Analysis. The journal of allergy and clinical immunology. In practice 2023. link
3 Nguyen NL, Chen K, McAleer J, Kolls JK. Vitamin D regulation of OX40 ligand in immune responses to Aspergillus fumigatus. Infection and immunity 2013. link
4 Agarwal R, Khan A, Gupta D, Aggarwal AN, Saxena AK, Chakrabarti A. An alternate method of classifying allergic bronchopulmonary aspergillosis based on high-attenuation mucus. PloS one 2010. link
5 Terho E, Frew AJ. Type III allergy skin testing. Position statement for EAACI Subcommittee on Skin Tests and Allergen Standardization. Allergy 1995. link
6 Kurup VP, Resnick A, Scribner GH, Gunasekaran M, Fink JN. Enzyme profile and immunochemical characterization of Aspergillus fumigatus antigens. The Journal of allergy and clinical immunology 1986. link90267-8)
7 Kurup VP, Ting EY, Fink JN. Immunochemical characterization of Aspergillus fumigatus antigens. Infection and immunity 1983. link