Highlights & Basics
- Allergic bronchopulmonary aspergillosis is a hypersensitivity reaction to bronchial colonization by Aspergillus fumigatus mold, typically affecting patients with asthma or cystic fibrosis.
- Exposure of atopic people to fungal spore elements results in the formation of immunoglobulin E and immunoglobulin G antibodies.
- Presents as asthma complicated by bronchial obstruction, fever, malaise, expectoration of brownish mucus plugs, peripheral blood eosinophilia, and hemoptysis.
- Treatment involves environmental control measures, corticosteroids, and azole antifungals.
- Early detection and treatment can prevent the development of bronchiectasis or pulmonary fibrosis that otherwise occurs in the later stages of the disease.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Chest x-ray in a patient with ABPA: ring shadows (long arrows) represent bronchiectatic airways seen in cross-section; tram lines (short arrow) seen longitudinally
Chest x-ray in a patient with ABPA: classic glove-finger pattern represents central bronchiectatic airways impacted with mucus
CT chest in a patient with ABPA: dilated, mucoid-impacted bronchiectatic airways
CT chest in a patient with ABPA: glove-finger shadow due to mucoid impaction in central bronchiectasis in a patient with asthma
Citations
Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 2002;110:685-692.[Abstract][Full Text]
Becker JW, Burke W, McDonald G, et al. Prevalence of allergic bronchopulmonary aspergillosis and atopy in adult patients with cystic fibrosis. Chest. 1996;109:1536-1540.[Abstract]
Patterson R, Greenberger PA, ,Halwig JM, et al. Allergic bronchopulmonary aspergillosis: natural history and classification of early disease by serologic and roentgenographic studies. Arch Intern Med. 1986;146:916-918.[Abstract]
Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Aug 15;63(4):e1-e60.[Abstract][Full Text]
Greenberger PA, Miller TP, Roberts M, et al. Allergic bronchopulmonary aspergillosis in patients with and without bronchiectasis. Ann Allergy. 1993;70:333-338.[Abstract]
Patterson R, Greenberger PA, Radin RC, et al. Allergic bronchopulmonary aspergillosis: staging as an aid to management. Ann Intern Med. 1982;96:286-291.[Abstract]
1. Greenberger PA. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 2002;110:685-692.[Abstract][Full Text]
2. Mahdavinia M, Grammer LC. Management of allergic bronchopulmonary aspergillosis: a review and update. Ther Adv Respir Dis. 2012;6:173-187.[Abstract]
3. Zander DS. Allergic bronchopulmonary aspergillosis: an overview. Arch Pathol Lab Med. 2005;129:924-928.[Abstract][Full Text]
4. Tillie-Leblond I, Tonnel AB. Allergic bronchopulmonary aspergillosis. Allergy. 2005;60:1004-1013.[Abstract][Full Text]
5. Sher TH, Schwartz HJ. Allergic Aspergillus sinusitis with concurrent allergic bronchopulmonary Aspergillus: report of a case. J Allergy Clin Immunol. 1988;81:844-846.[Abstract]
6. Eppinger TM, Greenberger PA, White DA, et al. Sensitization to Aspergillus species in the congenital neutrophil disorders chronic granulomatous disease and hyper-IgE syndrome. J Allergy Clin Immunol. 1999;104:1265-1272.[Abstract]
7. Agarwal R, Denning DW, Chakrabarti A. Estimation of the burden of chronic and allergic pulmonary aspergillosis in India. PLoS One. 2014;9(12):e114745.[Abstract][Full Text]
8. Virnig C, Bush RK. Allergic bronchopulmonary aspergillosis: a US perspective. Curr Opin Pulm Med. 2007;13:67-71.[Abstract]
9. Denning DW, Pleuvry A, Cole DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Med Mycol. 2013 May;51(4):361-70.[Abstract][Full Text]
10. Shah A, Panjabi C. Allergic aspergillosis of the respiratory tract. Eur Respir Rev. 2014 Mar 1;23(131):8-29.[Abstract][Full Text]
11. Basich JE, Graves TS, Baz MN, et al. Allergic bronchopulmonary aspergillosis in corticosteroid-dependent asthmatics. J Allergy Clin Immunol. 1981;68:98-102.[Abstract]
12. Cystic Fibrosis Foundation. Patient registry 1994 annual data report. Bethesda, MD: The Foundation; 1995.
13. Geller DE, Kaplowitz H, Light MJ, et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis: reported prevalence, regional distribution, and patient characteristics. Chest. 1999;116:639-646.[Abstract][Full Text]
14. Maturu VN, Agarwal R. Prevalence of Aspergillus sensitization and allergic bronchopulmonary aspergillosis in cystic fibrosis: systematic review and meta-analysis. Clin Exp Allergy. 2015 Dec;45(12):1765-78.[Abstract][Full Text]
15. Becker JW, Burke W, McDonald G, et al. Prevalence of allergic bronchopulmonary aspergillosis and atopy in adult patients with cystic fibrosis. Chest. 1996;109:1536-1540.[Abstract]
16. Kalaiyarasan, Jain AK, Puri M, et al. Prevalence of allergic bronchopulmonary aspergillosis in asthmatic patients: A prospective institutional study. Indian J Tuberc. 2018 Oct;65(4):285-289.[Abstract][Full Text]
17. Greenberger PA, Bush RK, Demain JG, et al. Allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract. 2014;2:703-708.[Abstract]
18. Gibson GP. Allergic bronchopulmonary aspergillosis. Semin Respir Crit Care Med. 2006;27:185-191.[Abstract]
19. Maurya V, Gugnani HC, Sarma PU, et al. Sensitization to Aspergillus antigens and occurrence of allergic bronchopulmonary aspergillosis in patients with asthma. Chest. 2005;127:1252-1259.[Abstract][Full Text]
20. Wark PA, Gibson PG. Allergic bronchopulmonary aspergillosis: new concepts of pathogenesis and treatment. Respirology. 2001;6:1-7.[Abstract]
21. Lazarus AA, Thilagar B, McKay SA. Allergic bronchopulmonary aspergillosis. Dis Mon. 2008;54:547-564.[Abstract]
22. Moss RB. Pathophisiology and immunology of allergic bronchopulmonary aspergillosis. Med Mycol. 2005;43(suppl 1):S203-S206.[Abstract]
23. Marchand E, Verellen-Dumoulin C, Mairesse M, et al. Frequency of cystic fibrosis transmembrane conductance regulator gene mutations and 5T allele in patients with allergic bronchopulmonary aspergillosis. Chest. 2001;119:762-767.[Abstract][Full Text]
24. Laufer P, Fink JN, Bruns WT, et a. Allergic bronchopulmonary aspergillosis in cystic fibrosis. J Allergy Clin Immunol. 1984;73:44-48.[Abstract]
25. Stevens DA, Moss RB, Kurup VP, et al. Allergic bronchopulmonary aspergillosis in cystic fibrosis: state of the art: Cystic Fibrosis Foundation consensus conference. Clin Infect Dis. 2003;37(suppl 3):S225-S264.[Abstract][Full Text]
26. Kraemer R, Delosea N, Ballinari P, et al. Effect of allergic bronchopulmonary aspergillosis on lung function in children with cystic fibrosis. Am J Respir Crit Care Med. 2006;174:1211-1220.[Abstract][Full Text]
27. Rapaka RR, Kolls JK. Pathogenesis of allergic bronchopulmonary aspergillosis in cystic fibrosis: current understanding and future directions. Med Mycol. 2009;47(suppl 1):S331-S337.[Abstract]
28. Chauhan B, Knutsen A, Hutcheson PS, et al. T cell subsets, epitope mapping, and HLA-restriction in patients with allergic bronchopulmonary aspergillosis. J Clin Invest. 1996;97:2324-2331.[Abstract][Full Text]
29. Brouard J, Knauer N, Boelle PY, et al. Influence of interleukin-10 on Aspergillus fumigatus infection in patients with cystic fibrosis. J Infect Dis. 2005;191:1988-1991.[Abstract][Full Text]
30. Saxena S, Madan T, Shah A, et al. Association of polymorphisms in the collagen region of SP-A2 with increased levels of total IgE antibodies and eosinophilia in patients with allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 2003;111:1001-1007.[Abstract]
31. Madan T, Reid KB, Singh M, et al. Susceptibility of mice genetically deficient in the surfactant protein (SP)-A or SP-D gene to pulmonary hypersensitivity induced by antigens and allergens of Aspergillus fumigatus. J Immunol. 2005;174:6943-6954.[Abstract][Full Text]
32. Miller PW, Hamosh A, Macej M Jr, et al. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in allergic bronchopulmonary aspergillosis. Am J Hum Genet. 1996;59:45-51.[Abstract][Full Text]
33. Patterson R, Greenberger PA, ,Halwig JM, et al. Allergic bronchopulmonary aspergillosis: natural history and classification of early disease by serologic and roentgenographic studies. Arch Intern Med. 1986;146:916-918.[Abstract]
34. Tonnel AB, Gosset P, Wallaert B. Allergic bronchopulmonary aspergillosis. In: Michel FB, Bousquet J, Godard P, eds. Highlights in asthmology. Berlin, Germany: Springer; 1987:58-65.
35. Schwartz HJ, Greenberger PA. The prevalence of allergic bronchopulmonary aspergillosis in patients with asthma, determined by serologic and radiologic criteria in patients at risk. J Lab Clin Med. 1991;117:138-142.[Abstract]
36. Agarwal R. Allergic bronchopulmonary aspergillosis. Chest. 2009;135:805-826.[Abstract]
37. Jederlinic PJ, Sicilian L, Gaensler EA. Chronic eosinophilic pneumonia: a report of 19 cases and a review of the literature. Medicine (Baltimore). 1988;67:154-162.[Abstract]
38. Patterson TF, Thompson GR 3rd, Denning DW, et al. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Aug 15;63(4):e1-e60.[Abstract][Full Text]
39. Casaulta C, Fluckiger S, Crameri R, et al. Time course of antibody response to recombinant Aspergillus fumigatus antigens in cystic fibrosis with and without ABPA. Pediatr Allergy Immunol. 2005;16:217-225.[Abstract]
40. Greenberger PA, Miller TP, Roberts M, et al. Allergic bronchopulmonary aspergillosis in patients with and without bronchiectasis. Ann Allergy. 1993;70:333-338.[Abstract]
41. Cystic Fibrosis Foundation. Allergic bronchopulmonary aspergillosis clinical care guidelines. 2003 [internet publication].[Full Text]
42. Nelson LA, Callerame ML, Schwartz RH. Aspergillosis and atopy in cystic fibrosis. Am Rev Respir Dis. 1979;120:863-873.[Abstract]
43. Mussaffi H, Greif J, Kornreich L, et al. Severe allergic bronchopulmonary aspergillosis in an infant with cystic fibrosis and her asthmatic father. Pediatr Pulmonol. 2000;29:155-159.[Abstract]
44. Agarwal R, Gupta D, Aggarwal AN, et al. Allergic bronchopulmonary aspergillosis: lessons from 126 patients attending a chest clinic in north India. Chest. 2006;130:442-448.[Abstract][Full Text]
45. Patterson R, Greenberger PA, Radin RC, et al. Allergic bronchopulmonary aspergillosis: staging as an aid to management. Ann Intern Med. 1982;96:286-291.[Abstract]
46. Shah A, Kala J, Sahay S, et al. Frequency of familial occurrence in 164 patients with allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol. 2008;101:363-369.[Abstract]
47. Pasteur MC, Bilton D, Hill AT; British Thoracic Society Bronchiectasis non-CF Guideline Group. British Thoracic Society guideline for non-CF bronchiectasis. Thorax. 2010;65(suppl 1):i1-i58.[Abstract][Full Text]
48. Marchand E, Reynaud-Gaubert M, Lauque D, et al. Idiopathic chronic eosinophilic pneumonia: a clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P). Medicine (Baltimore). 1998;77:299-312.[Abstract]
49. Cottin V, Frognier R, Monnot H, et al. Chronic eosinophilic pneumonia after radiation therapy for breast cancer. Eur Respir J. 2004;23:9-13.[Abstract][Full Text]
50. Guillevin L, Cohen P, Gayraud M, et al. Churg-Strauss syndrome: clinical study and long-term follow-up of 96 patients. Medicine (Baltimore). 1999;78:26-37.[Abstract]
51. Noth I, Strek ME, Leff AR. Churg-Strauss syndrome. Lancet. 2003;361:587-594.[Abstract]
52. Keogh KA, Specks U. Churg-Strauss syndrome: update on clinical, laboratory and therapeutic aspects. Sarcoidosis Vasc Diffuse Lung Dis. 2006;23:3-12.[Abstract]
53. Weller PF, Bubley GJ. The idiopathic hypereosinophilic syndrome. Blood. 1994;83:2759-2779.[Abstract][Full Text]
54. Cools J, DeAngelo DJ, Gotlib J, et al. A tyrosine kinase created by fusion of the PDGFRA and FIP1L1 genes as a therapeutic target of imatinib in idiopathic hypereosinophilic syndrome. N Engl J Med. 2003;348:1201-1214.[Abstract][Full Text]
55. Safirstein BH, D'Souza MF, Simon G, et al. Five-year follow-up of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis. 1973;108:450-459.[Abstract]
56. Wang JL, Patterson R, Roberts M, et al. The management of allergic bronchopulmonary aspergillosis. Am Rev Respir Dis. 1979;120:87-92.[Abstract]
57. Ricketti AJ, Greenberger PA, Patterson R. Serum IgE as an important aid in management of allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol. 1984;74:68-71.[Abstract]
58. British Thoracic Association. Inhaled beclomethasone dipropionate in allergic bronchopulmonary aspergillosis. Report to the Research Committee of the British Thoracic Association. Br J Dis Chest. 1979;73:349-356.[Abstract]
59. Seaton A, Seaton RA, Wightman AJ. Management of allergic bronchpulmonary aspergillosis without maintenance oral corticosteroids: a fifteen-year follow-up. QJM. 1994;87:529-537.[Abstract]
60. US Food and Drug Administration. FDA drug safety communication: FDA limits usage of Nizoral (ketoconazole) oral tablets due to potentially fatal liver injury and risk of drug interactions and adrenal gland problems. Jul 2013 [internet publication].[Full Text]
61. Skov M, Main KM, Sillesen IB, et al. Iatrogenic adrenal insufficiency as a side-effect of combined treatment of itraconazole and budesonide. Eur Respir J. 2002;20:127-133.[Abstract][Full Text]
62. Blanco-Dorado S, Marques Afonso AT, Bandín-Vilar EJ, et al. Voriconazole hepatotoxicity as a result of steroid withdrawal in a patient with allergic bronchopulmonary aspergillosis. Br J Clin Pharmacol. 2019 Feb;85(2):460-462.[Abstract][Full Text]
63. Cockrill BA, Hales CA. Allergic bronchopulmonary aspergillosis. Annu Rev Med. 1999;50:303-316.[Abstract]
64. American Lung Association Asthma Clinical Research Centers, Mastronarde JG, Anthonisen NR, et al. Efficacy of esomeprazole for treatment of poorly controlled asthma. N Engl J Med. 2009;360:1487-1499.[Abstract]
65. National Asthma Education and Prevention Program. Expert Panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma: summary report 2007. J Allergy Clin Immunol. 2007;120(5 suppl):S94-S138.[Abstract]
66. Zirbes JM, Milla CE. Steroid-sparing effect of omalizumab for allergic bronchopulmonary aspergillosis and cystic fibrosis. Pediatr Pulmonol. 2008;43:607-610.[Abstract]
67. Kanu A, Patel K. Treatment of allergic bronchopulmonary aspergillosis (ABPA) in CF with anti-IgE antibody (omalizumab). Pediatr Pulmonol. 2008;43:1249-1251.[Abstract]
68. van der Ent CK, Hoekstra H, Rijkers GT. Successful treatment of allergic bronchopulmonary aspergillosis with recombinant anti-IgE antibody. Thorax. 2007;62:276-277.[Abstract]
69. Moss RB. The use of biological agents for the treatment of fungal asthma and allergic bronchopulmonary aspergillosis. Ann N Y Acad Sci. 2012;1272:49-57.[Abstract][Full Text]
70. Lötvall J, Akdis CA, Bacharier LB, et al. Asthma endotypes: a new approach to classification of disease entities within the asthma syndrome. J Allergy Clin Immunol. 2011;127:355-360.[Abstract][Full Text]
71. Agarwal R, Aggarwal AN, Dhooria S. A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J. 2016;47:490-498.[Abstract]
72. Liu D, Ahmet A, Ward L, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013 Aug 15;9(1):30.[Abstract][Full Text]
73. Leon EE, Craig TJ. Antifungals in the treatment of allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol. 1999;82:511-516.[Abstract]
74. Greenberger PA. Allergic bronchopulmonary aspergillosis. In: Stevens DA, Moss RB, Kurup VP, eds. Middleton's allergy: principles and practice, 6th ed. Philadelphia, PA: Mosby; 2003:1353-1371.
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