Allergic bronchopulmonary aspergillosis

Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by a hypersensitivity reaction to the fungus Aspergillus fumigatus, which colonizes the airways. It predominantly affects individuals with pre-existing respiratory conditions, particularly asthma and cystic fibrosis. ABPA is characterized by an exaggerated immune response involving both type I (immediate) and type III (immune complex-mediated) hypersensitivity reactions, leading to chronic airway inflammation and, if untreated, progressive lung damage including bronchiectasis and pulmonary fibrosis. Key symptoms include recurrent episodes of wheezing, cough productive of brownish mucus plugs, low-grade fever, malaise, and worsening of underlying asthma that is poorly responsive to standard bronchodilator therapy. Patients may experience episodic pulmonary infiltrates visible on chest imaging. Laboratory findings typically include elevated total serum IgE, peripheral blood eosinophilia, positive skin prick test to Aspergillus antigens, and elevated Aspergillus-specific IgE and IgG antibodies. Central bronchiectasis on high-resolution CT scanning is a hallmark radiological feature. The primary treatment for ABPA involves systemic corticosteroids (such as prednisolone) to control the inflammatory and immunological response, often administered in tapering courses over several months. Antifungal agents, particularly itraconazole, are used as steroid-sparing adjunctive therapy to reduce fungal burden in the airways. Omalizumab, an anti-IgE monoclonal antibody, has shown promise in refractory cases. Early diagnosis and treatment are essential to prevent irreversible lung damage. Long-term monitoring of serum IgE levels and pulmonary function is recommended to detect relapses.

Data sourced from FDA regulatory filings and ClinicalTrials.gov. Updated periodically.

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