Allergic Bronchopulmonary Aspergillosis

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) was first reported by Hinson et al1Hinson KFW Moon AJ Plummer NS. Bronchopulmonary aspergillosis..Thorax. 1952; 7: 317-333Crossref PubMed Google Scholar in 1952. Major work on ABPA was done by Pepys et al2Pepys J Riddel RW Citron KM et al.Clinical and immunologic significance of Aspergillus fumigatus in the sputum..Am Rev Respir Dis. 1959; 80: 167-180PubMed Google Scholar and McCarthy and Pepys.3McCarthy DS Pepys J. Allergic bronchopulmonary aspergillosis: clinical immunology; 1. Clinical features..Clin Allergy. 1971; 1: 261-286Crossref Scopus (172) Google Scholar The first case of ABPA in the United States was reported in 1968.4Patterson R Golbert TM. Hypersensitivity disease of the lung..Univ Mich Med Cent J. 1968; 34: 8-11PubMed Google Scholar The patient, age 26 at the time of diagnosis, is now 57 years old and has had no progression of lung disease.5Patterson R Greenberger PA Roberts ML Allergic bronchopulmonary aspergillosis. Oceanside Publications, Providence, RI1995Google Scholar The Northwestern Allergy-Immunology (NUAI) series of ABPA patients served as the basis for the definition of clinical and serologic analyses and has been reported previously,5Patterson R Greenberger PA Roberts ML Allergic bronchopulmonary aspergillosis. Oceanside Publications, Providence, RI1995Google Scholar and a summary of our findings is shown in Table 1.TABLE 1Summary of Clinical, Laboratory, and Serologic Findings Consistent With a Diagnosis of ABPA*Reprinted with permission from Patterson et al.5StudiesDiagnostic ValueClinical or laboratory findings AsthmaABPA possible EosinophiliaABPA possible Fleeting pulmonary infiltratesABPA probable Central bronchiectasisABPA almost certainSerologic assessment 1. Precipitins against A fumigatus positiveAll four tests positive: diagnosis is established 2. IgE antibody > 2 times asthma controlThree tests positive: diagnosis very likely 3. IgG antibody > 2 times asthma control 4. Total serum IgE > 1,000 ng/mLTwo tests positive: diagnosis possibleClinical serologic resultConsistent with ABPA Total serum IgE declines by 50 to 75% after treatment with prednisone* Reprinted with permission from Patterson et al.5Patterson R Greenberger PA Roberts ML Allergic bronchopulmonary aspergillosis. Oceanside Publications, Providence, RI1995Google Scholar Open table in a new tab The stages of ABPA were determined by clinical experience treating patients with ABPA5Patterson R Greenberger PA Roberts ML Allergic bronchopulmonary aspergillosis. Oceanside Publications, Providence, RI1995Google Scholar and are shown in Figure 1. All patients with fibrotic end-stage lung disease originally identified are now deceased.5Patterson R Greenberger PA Roberts ML Allergic bronchopulmonary aspergillosis. Oceanside Publications, Providence, RI1995Google Scholar ABPA rarely progresses to stage V because ABPA is now diagnosed soon enough to prevent progression to end-stage lung disease. A comprehensive review of ABPA has been published in Immunology and Allergy Clinics of North America with V. P. Kurup, PhD, and A. J. Apter, MD, as guest editors.6Kurup V Apter AJ Immunology and Allergy Clinics of North America: allergic bronchopulmonary aspergillosis (vol 18). WB Saunders, Philadelphia, PA1998Google Scholar Important aspects relating to ABPA are reviewed, including ABPA and cystic fibrosis, cytokines in ABPA, fungal sinusitis, and the radiologic aspects of ABPA. In this issue of CHEST (see page 66), the article by Eaton et al is important for these reasons. It is consistent with the concept that ABPA is of worldwide distribution. ABPA should be excluded in all patients with asthma because, if undiagnosed, progressive lung damage may occur. Cutaneous (puncture) testing with Aspergillus fumigatus is associated with the presence of IgE antibodies and some cases of ABPA. In the NUAI series of ABPA patients, a classification of ”ABPA-CB” is used when central bronchiectasis is present. ”ABPA-Serologic”5Patterson R Greenberger PA Roberts ML Allergic bronchopulmonary aspergillosis. Oceanside Publications, Providence, RI1995Google Scholar is used to define patients who are positive in all serologic studies but do not have central bronchiectasis. The importance of serologic assessment was emphasized by the occurrence of ABPA in posttransplant lungs of a patient with cystic fibrosis and ABPA prior to lung transplantation.7Fitzsimons EJ Aris R Patterson R. Recurrence of allergic bronchopulmonary aspergillosis in the posttransplant lungs of a cystic fibrosis patient..Chest. 1997; 112: 281-282Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar