Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that often occurs in patients with asthma or cystic fibrosis (CF) and is characterized by a hypersensitivity response to the allergens of the fungus Aspergillus fumigatus. In patients with CF, growth of A. fumigatus hyphae within...

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Main Authors: Ibrahim Ahmed Janahi, Abdul Rehman, Amal Rashid Al-Naimi
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2017-01-01
Series:Annals of Thoracic Medicine
Subjects:
Online Access:http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2017;volume=12;issue=2;spage=74;epage=82;aulast=Janahi
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spelling doaj-0363df035fc04805b38223e205e305192020-11-24T23:12:09ZengWolters Kluwer Medknow PublicationsAnnals of Thoracic Medicine1817-17371998-35572017-01-01122748210.4103/atm.ATM_231_16Allergic bronchopulmonary aspergillosis in patients with cystic fibrosisIbrahim Ahmed JanahiAbdul RehmanAmal Rashid Al-NaimiAllergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that often occurs in patients with asthma or cystic fibrosis (CF) and is characterized by a hypersensitivity response to the allergens of the fungus Aspergillus fumigatus. In patients with CF, growth of A. fumigatus hyphae within the bronchial lumen triggers an immunoglobulin E (IgE)-mediated hypersensitivity response that results in airway inflammation, bronchospasm, and bronchiectasis. In most published studies, the prevalence of ABPA is about 8.9% in patients with CF. Since the clinical features of this condition overlap significantly with that of CF, ABPA is challenging to diagnose and remains underdiagnosed in many patients. Diagnosis of ABPA in CF patients should be sought in those with evidence of clinical and radiologic deterioration that is not attributable to another etiology, a markedly elevated total serum IgE level (while off steroid therapy) and evidence of A. fumigatus sensitization. Management of ABPA involves the use of systemic steroids to reduce inflammation and modulate the immune response. In patients who do not respond to steroids or cannot tolerate them, antifungal agents should be used to reduce the burden of A. fumigatus allergens. Recent studies suggest that omalizumab may be an effective option to reduce the frequency of ABPA exacerbations in patients with CF. Further randomized controlled trials are needed to better establish the efficacy of omalizumab in managing patients with CF and ABPA.http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2017;volume=12;issue=2;spage=74;epage=82;aulast=JanahiAllergic bronchopulmonary aspergillosisallergic fungal mycosiscystic fibrosis
collection DOAJ
language English
format Article
sources DOAJ
author Ibrahim Ahmed Janahi
Abdul Rehman
Amal Rashid Al-Naimi
spellingShingle Ibrahim Ahmed Janahi
Abdul Rehman
Amal Rashid Al-Naimi
Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis
Annals of Thoracic Medicine
Allergic bronchopulmonary aspergillosis
allergic fungal mycosis
cystic fibrosis
author_facet Ibrahim Ahmed Janahi
Abdul Rehman
Amal Rashid Al-Naimi
author_sort Ibrahim Ahmed Janahi
title Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis
title_short Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis
title_full Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis
title_fullStr Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis
title_full_unstemmed Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis
title_sort allergic bronchopulmonary aspergillosis in patients with cystic fibrosis
publisher Wolters Kluwer Medknow Publications
series Annals of Thoracic Medicine
issn 1817-1737
1998-3557
publishDate 2017-01-01
description Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that often occurs in patients with asthma or cystic fibrosis (CF) and is characterized by a hypersensitivity response to the allergens of the fungus Aspergillus fumigatus. In patients with CF, growth of A. fumigatus hyphae within the bronchial lumen triggers an immunoglobulin E (IgE)-mediated hypersensitivity response that results in airway inflammation, bronchospasm, and bronchiectasis. In most published studies, the prevalence of ABPA is about 8.9% in patients with CF. Since the clinical features of this condition overlap significantly with that of CF, ABPA is challenging to diagnose and remains underdiagnosed in many patients. Diagnosis of ABPA in CF patients should be sought in those with evidence of clinical and radiologic deterioration that is not attributable to another etiology, a markedly elevated total serum IgE level (while off steroid therapy) and evidence of A. fumigatus sensitization. Management of ABPA involves the use of systemic steroids to reduce inflammation and modulate the immune response. In patients who do not respond to steroids or cannot tolerate them, antifungal agents should be used to reduce the burden of A. fumigatus allergens. Recent studies suggest that omalizumab may be an effective option to reduce the frequency of ABPA exacerbations in patients with CF. Further randomized controlled trials are needed to better establish the efficacy of omalizumab in managing patients with CF and ABPA.
topic Allergic bronchopulmonary aspergillosis
allergic fungal mycosis
cystic fibrosis
url http://www.thoracicmedicine.org/article.asp?issn=1817-1737;year=2017;volume=12;issue=2;spage=74;epage=82;aulast=Janahi
work_keys_str_mv AT ibrahimahmedjanahi allergicbronchopulmonaryaspergillosisinpatientswithcysticfibrosis
AT abdulrehman allergicbronchopulmonaryaspergillosisinpatientswithcysticfibrosis
AT amalrashidalnaimi allergicbronchopulmonaryaspergillosisinpatientswithcysticfibrosis
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