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Communications to the Editor |

Allergic Bronchopulmonary Aspergillosis or Bronchopulmonary Aspergillosis With Asthma : Which One Is More Appropriate ? FREE TO VIEW

Parthasarathi Bhattacharyya, MD, DM
Author and Funding Information

Calcutta, India

Correspondence to: Parthasarathi Bhattacharyya, MD, DM, AK-46, Sector-II, Salt Lake, Calcutta-700091, India



Chest. 1999;116(6):1844-1845. doi:10.1378/chest.116.6.1844
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To the Editor:

The term “allergic bronchopulmonary aspergillosis” (ABPA) has not been well defined since its first use in 1952.1ABPA is a condition caused by Aspergillus colonization occurring in a patient with asthma that manifests itself as an allergic response that is apparent from the presence of peripheral eosinophilia (> 1,000/μL), an increased amount of total and Aspergillus-specific IgE and IgG, and the presence of immediate wheal and flare response of type-I hypersensitivity,2with good clinical response to steroid therapy.3But, there are other clinical findings that cannot be explained by allergy or type-1 hypersensitivity. ABPA features tissue destruction, which is evident from occasional mucopurulent sputum, and even small instances of hemoptysis, with fever that often causes confusion with bacterial pneumonia.4 Radiologically, there is evidence of consolidation and atelectasis and finger-like shadows on radiographs of patients in the acute state,5and there are features of fibrosis and proximal bronchiectasis, and even extensive lung destruction in chronic cases.67 Serologically, the IgG level is raised and the serum precipitin test is positive for Aspergillus.2 ABPA has a spectrum of clinical variations, with some patients showing progressive lung damage despite steroid therapy,6 and there have also even been cases of amyloidosis secondary to ABPA.8 Hence, there must be elements of other types of hypersensitivity reactions concomitant with the type-1 reaction.

So, use of the generalized term “allergic” in “allergic bronchopulmonary aspergillosis” is an oversimplification of the condition. As long as ABPA is not further classified on a more stringent scientific basis, a term such as “bronchopulmonary aspergillosis with asthma” would perhaps be more appropriate and descriptive.

Hinson, KFW, Moon, AJ, Plummer, NS (1952) Bronchopulmonary aspergillosis.Thorax7,317-333. [PubMed] [CrossRef]
 
Rosenberg, M, Patterson, R, Mintzer, R, et al Clinical and immunological criteria for diagnosis of allergic bronchopulmonary aspergillosis.Ann Intern Med1977;86,405-414. [PubMed]
 
McCarthy, D, Pepys, J Allergic bronchopulmonary aspergillosis. Clinical immunology: clinical features.Clin Allergy1971;1,261-286
 
Davies, SF, Sarosi, GA Allergic bronchopulmonary aspergillosis. Murry, JF Nadal, JA eds.The textbook of respiratory medicine 2nd ed.1994,1189-1190 W B Saunders. Philadelphia, PA:
 
McCarthy, DS, Simon, G, Hargreave, FE The radiological appearance in allergic bronchopulmonary aspergillosis.Clin Radiol1970;21,366-375. [PubMed]
 
Melo, JL, Hawkins, R, Pepys, J Studies in chronic bronchopulmonary aspergillosis: 1. Clinical and physiological findings.Thorax1977;3,257-261
 
Melo, JL, Pepys, J, Simon, G Studies in chronic bronchopulmonary aspergillosis: 2. Radiological findings.Thorax1977;32,262-268. [PubMed]
 
Winter, JH, Milroy, R, Stevenson, RD, et al Secondary amyloidosis in association with aspergillus lung disease.Br J Dis Chest1986;80,400-403. [PubMed]
 

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Tables

References

Hinson, KFW, Moon, AJ, Plummer, NS (1952) Bronchopulmonary aspergillosis.Thorax7,317-333. [PubMed] [CrossRef]
 
Rosenberg, M, Patterson, R, Mintzer, R, et al Clinical and immunological criteria for diagnosis of allergic bronchopulmonary aspergillosis.Ann Intern Med1977;86,405-414. [PubMed]
 
McCarthy, D, Pepys, J Allergic bronchopulmonary aspergillosis. Clinical immunology: clinical features.Clin Allergy1971;1,261-286
 
Davies, SF, Sarosi, GA Allergic bronchopulmonary aspergillosis. Murry, JF Nadal, JA eds.The textbook of respiratory medicine 2nd ed.1994,1189-1190 W B Saunders. Philadelphia, PA:
 
McCarthy, DS, Simon, G, Hargreave, FE The radiological appearance in allergic bronchopulmonary aspergillosis.Clin Radiol1970;21,366-375. [PubMed]
 
Melo, JL, Hawkins, R, Pepys, J Studies in chronic bronchopulmonary aspergillosis: 1. Clinical and physiological findings.Thorax1977;3,257-261
 
Melo, JL, Pepys, J, Simon, G Studies in chronic bronchopulmonary aspergillosis: 2. Radiological findings.Thorax1977;32,262-268. [PubMed]
 
Winter, JH, Milroy, R, Stevenson, RD, et al Secondary amyloidosis in association with aspergillus lung disease.Br J Dis Chest1986;80,400-403. [PubMed]
 
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