Let’s switch away from
and talk about allergic
bronchopulmonary aspergillosis or ABPA.
This is something we see in
children not that infrequently
and we should all
be aware of it.
So ABPA is a hypersensitivity
which is in the environment
Maybe you haven’t seen before,
it’s only present in 1% to
2% of patients with asthma,
and a higher percentage, 7% to 9%,
of patients with cystic fibrosis.
This is an antibody mediated
through IgG and IgE response
to Aspergillus that’s
getting in the airway.
If you will, the
Aspergillus gets in
and then there’s a hyperresponsiveness
to that Aspergillus,
sort of like a type 1
where there’s more antibodies going in and
attacking the Aspergillus inappropriately.
This in turn results in inflammation,
bronchial obstruction, mucus production.
These patients are at risk
for eosinophilic pneumonia
and you may see even
granulomas on chest x-ray.
When do we think about allergic
bronchopulmonary aspergillosis or ABPA?
We typically think about it in a child
with asthma or cystic fibrosis,
who isn’t responding to standard therapy
for their respiratory condition.
We can get a skin prick and notice
increased sensitivity to Aspergillus,
a wheal will be raised where the Aspergillus
protein was injected into the skin,
or we can check titers
in the blood for IgE
and notice a very high IgE level,
which is consistent with the disease.
Patients on chest x-ray
will show infiltrates
that are not responding
to standard antibiotics.
And what’s interesting here is
that a CBC may in fact be helpful
because you may see
eosinophilia on the CBC,
which is not really looking
for a high white count,
but particularly looking for
high levels of eosinophils.
If a patient has ABPA, we will typically
treat them with itraconazole,
which is targeted against the Aspergillus,
which is causing the systemic symptoms.
We will often put these
patients on steroids
and it’ll be a prolonged steroid taper
over three to six months to avoid relapse.
So these patients often have
problems with their steroids.
We’re going to monitor their IgE levels
and follow their chest x-ray
for resolution of symptoms.