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Key Features

  • A bronchopulmonary hypersensitivity disorder caused by allergy to fungal antigens

  • Commonly referred to as allergic bronchopulmonary aspergillosis (ABPA)

  • Seen in atopic asthmatic persons aged 20–40 years, usually in response to Aspergillus species

Clinical Findings

  • Symptoms

    • Dyspnea

    • Wheezing

    • Cough

    • Brown-flecked sputum

  • Relapses after therapy are common

  • Complications

    • Bronchiectasis

    • Hemoptysis

    • Pulmonary fibrosis

Diagnosis

  • Primary criteria

    • Clinical history of asthma or cystic fibrosis

    • Elevated serum total IgE levels (typically > 1000 international units/mL; a value < 1000 international units/mL may be used if all other criteria are met

    • Immediate cutaneous hypersensitivity to Aspergillus antigens or elevated serum IgE levels specific to A fumigatus

    • At least two of the following:

      • Precipitating serum antibodies to Aspergillus antigen or elevated serum Aspergillus IgG by immunoassay

      • Radiographic pulmonary opacities consistent with ABPA

      • Peripheral blood eosinophil count > 500 cells/mcL

    • History of asthma

    • Peripheral eosinophilia

    • Immediate skin reactivity to Aspergillus antigen

    • Precipitating antibodies to Aspergillus antigen

    • Elevated serum IgE levels

    • Pulmonary infiltrates

    • Central bronchiectasis

  • Secondary criteria

    • Aspergillus in sputum

    • History of brown-flecked sputum

    • Delayed skin reactivity to Aspergillus antigen

  • Presence of primary criteria 1–6 makes diagnosis almost certain

Treatment

  • Prednisone

    • Initial dose: 0.5–1 mg/kg orally per day) for at least 2 weeks

    • Dose can then be reduced or converted to every other day and slowly tapered over 3–6 months depending on the clinical situation

  • Itraconazole, 200 mg orally three times a day for 3 days followed by twice daily (with food if capsule formulation is used) for at least 16 weeks, may be added for corticosteroid-dependent patients

  • Bronchodilators are helpful (see Table 9–5)

Table 9–5.Quick-relief medications for asthma.

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