Allergic Bronchopulmonary Aspergillosis (ABPA)

00:01 Let’s switch away from pulmonary embolism and talk about allergic bronchopulmonary aspergillosis or ABPA.

00:10 This is something we see in children not that infrequently and we should all be aware of it.

00:16 So ABPA is a hypersensitivity to Aspergillus, which is in the environment almost ubiquitously.

00:25 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.

00:38 This is an antibody mediated through IgG and IgE response to Aspergillus that’s getting in the airway.

00:47 If you will, the Aspergillus gets in and then there’s a hyperresponsiveness to that Aspergillus, sort of like a type 1 autoimmune response, where there’s more antibodies going in and attacking the Aspergillus inappropriately.

01:05 This in turn results in inflammation, bronchial obstruction, mucus production.

01:12 These patients are at risk for eosinophilic pneumonia and you may see even granulomas on chest x-ray.

01:19 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.

01:34 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.

01:56 Patients on chest x-ray will show infiltrates that are not responding to standard antibiotics.

02:02 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.

02:17 If a patient has ABPA, we will typically treat them with itraconazole, which is targeted against the Aspergillus, which is causing the systemic symptoms.

02:28 We will often put these patients on steroids and it’ll be a prolonged steroid taper over three to six months to avoid relapse.

02:38 So these patients often have problems with their steroids.

02:43 We’re going to monitor their IgE levels and follow their chest x-ray for resolution of symptoms.