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Key Features

  • A bronchopulmonary hypersensitivity disorder caused by allergy to fungal antigens

  • 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

Clinical Findings

  • Symptoms

    • Dyspnea

    • Wheezing

    • Cough

  • Relapses after therapy are common

  • Complications

    • Hemoptysis

    • Severe bronchiectasis

    • Pulmonary fibrosis


  • 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 accepted 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 abnormalities consistent with ABPA

      • Peripheral blood eosinophil count > 500 cells/mcL (0.5 × 109/L)

  • Radiographic abnormalities include

    • Transient opacities

    • Mucoid impaction

    • Proximal or central bronchiectasis


  • High-dose corticosteroids (eg, prednisone 0.5–1 mg/kg orally per day) for at least 2 weeks with gradual taper is the treatment of choice

  • Patients with corticosteroid-dependent disease may benefit from itraconazole or voriconazole

  • Relapses are frequent

  • For those with frequent exacerbations, the use of biologic agents (eg, anti-IgE [omalizumab], anti-interleukin [IL]-5 [mepolizumab, benralizumab], or anti-IL4 receptor [dupilumab]), has been shown to improve outcomes

  • Bronchodilators may also be helpful

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