Allergic bronchopulmonary aspergillosis

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is characterized by a complex hypersensitivity reaction in response to airway colonization by the fungus Aspergillus fumigatus (Af). After inhaling Af spores, the immune response will differ according to the patient, with IgE-mediated mechanisms predominating. This disease is commonly diagnosed in patients with asthma and frequent exacerbations or patients with cystic f ibrosis who present clinical deterioration despite therapeutic optimization. The diagnostic criteria for ABPA currently used date back to 2013. However, this disease implies a complex differential diagnostic approach, and is often underdiagnosed. Nowadays, ABPA treatment consists of corticosteroids and antifungal agents, but new biological agents used in severe asthma seem a promising approach, with good clinical results. The aim of this review is to present the main pathophysiological mechanisms, focusing on the clinical, diagnostic, and differential diagnostic approach, as well as the therapeutic management of ABPA.