Allergic bronchopulmonary aspergillosis B44.9

Hinson et al.,1952

Allergic bronchopulmonary aspergillosis (ABPA) is based on an immunological reaction to fungal antigens, especially those of Aspergillus spp. (in principle, other fungi can also trigger this disease). It is considered the most common cause of pulmonary eosinophilia (see eosinophilic pneumonia below). ABPA occurs in 10-15% of cases complicating cystic fibrosis (cystic fibrosis).

2-15% of patients with cystic fibrosis suffer from ABPA

Immunological reaction of type I and type III against Aspergillus species (see below Aspergillosis), especially Aspergillus fumigatus. Other Aspergillusspecies like:

• Aspergillus flavus
• Aspergillus niger
• Aspergillus terreus and
• aspergillus nidulans

a role.

Children and adults

The symptoms begin insidiously with increasing asthmatic complaints, inexplicable fever attacks, haemoptysis, chest pain, weight loss, myalgia. A dyscratic line with formation of thick mucus can lead to so-called "mycoid impactions" and centrally located bronchiectasis.

ABPA is more common in people who already suffer from bronchial asthma or cystic fibrosis.

ABPA is divided into 5 stages:

• I (initial manifestation)
• II (remission - temporary reduction of symptoms)
• III (exacerbation)
• IV (bronchial asthma requiring corticoids)
• V (irreversible fibrotic reconstruction of the lung skeleton)

X-ray of the lungs or CT of the lungs: large-area shadows (bronchial secretion congestion = mucoid impactions), often also central bronchiectasis.

Diagnostic criteria of allergic bronchopulmonary aspergillosis (var. N. Kroegel C and Costabel U)

• Recurrent bronchial asthma
• Cutaneous immediate reaction to Aspergillus spp.
• IgE antibodies against Aspergillus spp. (major markers Asp fum, Asp f4 and Asp f6)
• Bloteosinophils
• Volatile lung infiltrates
• Central Bronchiectasis
• Late cutaneous reaction to Aspergillus spp.
• sputum eosinophilia
• Detection of Aspergillus spp in sputum

Allergic aspergillosis must be distinguished from (systemic) infectious aspergillosis, which is often fatal.

Furthermore, cystic fibrosis and tuberculosis are possible differential diagnoses.

Systemic and inhalative treatment with a glucocorticosteroid. Supplementation with an antimycotic (e.g. itraconazole); possibly bronchodilators as in bronchial asthma.

Experimental: Anti-IgE therapy with Omalizumab

As a precaution, care should be taken to avoid stored plant materials such as hay, compost, (containing Aspergillus) (elimination of house plants, feather beds, no pets, especially birds).

Without treatment, risk of progressive fibrotic remodeling of the lung armor (irreversible fibrosis).

In rare "complicative" cases, allergic bronchopulmonary aspergillosis may be combined with eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) (Ren S 2013).

1. Agarwal R et al (2013) ABPA complicating asthma ISHAM working group... Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy 43:850-873.
2. Greenberger PA et al (2014) Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract 2:703-708.
3. Hinson KF et al (1952) Broncho-pulmonary aspergillosis; a review and a report of eight new cases. Thorax. 7: 317-333.
4. Jat KR et al (2013) Anti-IgE therapy for allergic bronchopulmonary aspergillosis in people with cystic fibrosis. Cochrane Database Syst Rev 17:CD010288.
5. Kroegel C et al (2000) Eosinophilic pneumonia and eosinophilic gastroenteritis. In: Przybylla B et al (eds) Practical allergic diagnostics. Steinkopff-Verlag Darmstadt p.314
6. Maturu VN et al. (2015) Acute Invasive Pulmonary Aspergillosis Complicating Allergic Bronchopulmonary Aspergillosis: Case Report and Systematic Review. Mycopathologia 180(3-4):209-215.
7. Moreira AS et al (2014) Antifungal treatment in allergic bronchopulmonary aspergillosis with and without cystic fibrosis: a systematic review. Clin Exp Allergy 44:1210-1227.

8. Patel G et al (2019) Allergic bronchopulmonary aspergillosis. Allergy Asthma Proc 40:421-424.
   

9. Ren S (2013) Combined Churg-Strauss syndrome and allergic bronchopulmonary aspergillosis - case report and review of the literature. Clin Respir J 7:e6-10.

10. Zhou Y et al (2015) Allergic bronchopulmonary aspergillosis in children.Pediatr Int 57):e73-76 .