Allergic Bronchopulmonary Aspergillosis: Diagnostic and Treatment Challenges
Lucia Leonardi*, Bianca Laura Cinicola, Rossella Laitano and Marzia Duse
Department of Pediatrics and Child Neuropsychiatry, Division of Allergy and Clinical Immunology, Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
- Corresponding Author:
- Lucia Leonardi
Department of Pediatrics, Division of Allergy and Clinical Immunology
Sapienza University of Rome, Policlinico Umberto I, Rome, Italy
Tel: +39 3471277845
Fax: +39 0649979377
E-mail: [email protected], [email protected]
Received Date: June 21, 2016; Accepted Date: July 15, 2016; Published Date: July 19, 2016
Citation: Leonardi L, Cinicola BL, Laitano R, Duse M (2016) Allergic Bronchopulmonary Aspergillosis: Diagnostic and Treatment Challenges. J Pulm Respir Med 6:361. doi: 10.4172/2161-105X.1000361
Copyright: © 2016 Leonardi L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder, occurring mostly in asthmatic and cystic fibrosis patients, caused by an abnormal T-helper 2 lymphocyte response of the host to Aspergillus fumigatus antigens. ABPA diagnosis is defined by clinical, laboratory and radiological criteria including active asthma, immediate skin reactivity to A. fumigatus antigens, total serum IgE levels>1000 IU/mL, fleeting pulmonary parenchymal opacities and central bronchiectases that represent an irreversible complication of ABPA. Despite advances in our understanding of the role of the allergic response in the pathophysiology of ABPA, pathogenesis of the disease is still not completely clear. In addition, the absence of consensus regarding its prevalence, diagnostic criteria and staging limits the possibility of diagnosing the disease at early stages. This may delay the administration of a therapy that can potentially prevent permanent lung damage. Long-term management is still poorly studied. Present primary therapies, based on clinical experience, are not yet standardized. These consist in oral corticosteroids, which control acute symptoms by mitigating the allergic inflammatory response, azoles and, more recently, anti-IgE antibodies. The latter two are used as a steroid-sparing agent to prolong the remission stage of the disease. Anti-IgE antibodies also have immunomodulatory properties. At present, the only way to bypass these limits and allow for an early diagnosis, is to assume ABPA in all patients with difficult-to-control asthma or cystic fibrosis. They should then be screened for sensitization to A. fumigatus antigens and, if positive, monitored more closely. Future controlled studies are needed to standardize present therapy, standardize cut-off values of various investigations, define the role of different novel immunomodulatory therapies, define the role of novel assays (such as recombinant A. fumigatus antigens and CCL17) and confirm new diagnostic and staging criteria.