Marked peripheral eosinophilia: a clue to allergic bronchopulmonary aspergillosis in office practice

Allergic Bronchopulmonary Aspergillosis (ABPA) is not rare. A diagnosis of "clinically probable ABPA" should be suspected in asthmatics who are not well controlled on adequate bronchodilators, who are steroid dependent or who have recurrent pulmonary infiltrates, and who also have a positive skin test with a separate aspergillus extract. Suspicion should also stimulate pursuit of this diagnosis in asthmatics with a total eosinophil count over 500 cells/mm3 or a total serum IgE level over 1,000 IU/ml. Early detection in office practice is feasible, practical, and may be critical to avoidance of permanent pulmonary damage.