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Allergic bronchopulmonary aspergillosis (ABPA) (or mycosis) is a pulmonary hypersensitivity disorder caused by allergy to fungal antigens that colonize the tracheobronchial tree. It usually occurs in atopic asthmatic individuals who are 20–40 years of age or those with cystic fibrosis, in response to antigens of Aspergillus species. Primary criteria for the diagnosis of ABPA include (1) a clinical history of asthma or cystic fibrosis; (2) elevated serum total IgE levels (typically greater than 1000 international units/mL; a value less than 1000 international units/mL may be acceptable if all other criteria are met); (3) immediate cutaneous hypersensitivity to Aspergillus antigens or elevated serum IgE levels specific to Aspergillus fumigatus; and (4) at least two of the following: (a) precipitating serum antibodies to Aspergillus antigen or elevated serum Aspergillus IgG by immunoassay, (b) radiographic pulmonary opacities consistent with ABPA, or (c) peripheral blood eosinophil count greater than 500 cells/mcL (greater than 0.5 × 109/L). High-dose corticosteroids (eg, prednisone 0.5–1 mg/kg orally per day) for at least 2 weeks is the treatment of choice. Depending on the clinical situation, the corticosteroid dose can then be reduced and tapered over 3–6 months. Relapses are frequent, and repeated treatment with corticosteroid is not uncommon. Patients with corticosteroid-dependent disease may benefit from itraconazole or voriconazole. Bronchodilators (see Table 9–3) may also be helpful. Complications include hemoptysis, severe bronchiectasis, and pulmonary fibrosis.

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