Affiliations: Northwestern University Medical School, Chicago, IL
Dr. Patterson, Dr. Greenberger, and Ms. Harris are in the Allergy-Immunology Division of the Department of Medicine of Northwestern University Medical School.
Supported by the Ernest S. Bazley Grant to Northwestern Memorial Hospital and Northwestern University Medical School and USPHS Grant AI 42349.
Correspondence to: Roy Patterson, MD, FCCP, Northwestern University Medical School, Ernest S. Bazley Asthma and Allergic Diseases Center, Medicine/Allergy MC-S207, 303 E. Chicago Ave, Chicago, IL 60611
Allergic bronchopulmonary aspergillosis (ABPA) was first
reported by Hinson et al1in 1952. Major work on ABPA was
done by Pepys et al2and McCarthy and Pepys.3–
The first case of ABPA in the United States was reported in
1968.4The patient, age 26 at the time of diagnosis, is
now 57 years old and has had no progression of lung
disease.5 The Northwestern Allergy-Immunology (NUAI)
series of ABPA patients served as the basis for the definition of
clinical and serologic analyses and has been reported
previously,5 and a summary of our findings is shown in
The stages of ABPA were determined by clinical experience treating
patients with ABPA5 and are shown in Figure 1
. All patients with fibrotic end-stage lung disease originally
identified are now deceased.,5 ABPA rarely progresses to
stage V because ABPA is now diagnosed soon enough to prevent
progression to end-stage lung disease.
A comprehensive review of ABPA has been published in Immunology
and Allergy Clinics of North America with V. P. Kurup, PhD,
and A. J. Apter, MD, as guest editors.6 Important
aspects relating to ABPA are reviewed, including ABPA and cystic
fibrosis, cytokines in ABPA, fungal sinusitis, and the radiologic
aspects of ABPA.
In this issue of CHEST (see page 66), the article by Eaton
et al is important for these reasons. It is consistent with the concept
that ABPA is of worldwide distribution. ABPA should be excluded in all
patients with asthma because, if undiagnosed, progressive lung damage
may occur. Cutaneous (puncture) testing with Aspergillus
fumigatus is associated with the presence of IgE antibodies and
some cases of ABPA.
In the NUAI series of ABPA patients, a classification of “ABPA-CB”
is used when central bronchiectasis is present.“
ABPA-Serologic”5 is used to define patients who are
positive in all serologic studies but do not have central
bronchiectasis. The importance of serologic assessment was emphasized
by the occurrence of ABPA in posttransplant lungs of a patient with
cystic fibrosis and ABPA prior to lung transplantation.7
Reprinted with permission from Patterson et
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