Aspergillose bronchopulmonaire allergique

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a respiratory disease that affects 1–2% of asthmatics and up to 9% of patients with cystic fibrosis. The complex immune reactions in ABPA involve IgE and also IgG, with activation of Th2 lymphocytes on previously activated/injured epithelium. The genetic terrain is essential in promoting its onset, and ABPA is associated with certain HLA-DR and DQ polymorphisms in the gene encoding IL-4RA, surfactant protein A2, or mutations of the CFTR gene, which probably play a key role. When the diagnosis is established on the basis of these criteria, two types have been identified: seropositive ABPA and ABPA with bronchiectasis. Treatment involves systemic corticosteroids and itraconazole. Several studies suggest a beneficial role for omalizumab, but only placebo-controlled studies will clarify its indication in ABPA.