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Related Experiment Videos

Allergic bronchopulmonary aspergillosis.

Richard B Moss1

  • 1Department of Pediatrics, Stanford University, Palo Alto, CA, USA. rmoss@stanford.edu

Clinical Reviews in Allergy & Immunology
|August 7, 2002
PubMed
Summary

Allergic bronchopulmonary aspergillosis (ABPA) affects about 10% of cystic fibrosis (CF) patients. Diagnosis involves specific criteria, and treatment primarily uses steroids, with itraconazole as a steroid-sparing option.

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Area of Science:

  • Pulmonology
  • Immunology
  • Allergy

Background:

  • Allergic bronchopulmonary aspergillosis (ABPA) is a significant complication in cystic fibrosis (CF), impacting approximately 10% of patients.
  • ABPA pathogenesis involves impaired fungal clearance, respiratory epithelial exposure to Aspergillus fumigatus (Af) spores, and Th2 lymphocyte recruitment.
  • Risk factors for ABPA susceptibility include atopy and specific major histocompatibility complex alleles.

Purpose of the Study:

  • To outline the pathogenesis, diagnostic criteria, and management strategies for ABPA in CF patients.
  • To highlight the role of specific Af molecules in ABPA development.
  • To emphasize the importance of regular screening and monitoring for ABPA in CF.

Main Methods:

  • Review of current literature on ABPA in CF.
  • Identification of diagnostic criteria including clinical, serological, and radiological markers.
  • Evaluation of treatment options, including systemic glucocorticosteroids and itraconazole.

Main Results:

  • Distinct cytoplasmic Af molecules (Af2, 4, and 6) are associated with ABPA.
  • Minimal diagnostic criteria for ABPA in CF include clinical deterioration, elevated total serum IgE, positive Af sensitization, and radiographic or serological evidence of Af infection.
  • Annual screening of total serum IgE from age 6 is recommended.

Conclusions:

  • Systemic glucocorticosteroids are the primary treatment for ABPA in CF.
  • Itraconazole serves as a crucial steroid-sparing agent for patients with poor steroid response, relapses, or steroid toxicity risks.
  • Close monitoring of clinical, radiographic, and laboratory parameters, especially total serum IgE, is essential for effective ABPA management in CF.

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