PMID- 22167396
OWN - NLM
STAT- MEDLINE
DCOM- 20120403
LR  - 20220408
IS  - 1098-9048 (Electronic)
IS  - 1069-3424 (Linking)
VI  - 32
IP  - 6
DP  - 2011 Dec
TI  - Allergic bronchopulmonary aspergillosis and related allergic syndromes.
PG  - 682-92
LID - 10.1055/s-0031-1295716 [doi]
AB  - While allergic bronchopulmonary aspergillosis (ABPA) is well recognized as a 
      fungal complication of asthma, severe asthma with fungal sensitization (SAFS) is 
      not. In ABPA the total immunoglobulin E (IgE) is usually >1,000 IU/mL, whereas in 
      SAFS it is <1,000 IU/mL, and either skin prick tests or fungus-specific IgE tests 
      are positive. ABPA may present with any severity of asthma, and occasionally with 
      no asthma or cystic fibrosis, the other common underlying disease. SAFS is a 
      problem in patients with poorly controlled asthma and occasionally presents in 
      the intensive care unit (ICU). Production of mucous plugs and coughing paroxysms 
      is more common in ABPA. Certain underlying genetic defects seem to underpin these 
      remarkable phenotypic differences. From a management perspective both ABPA and 
      SAFS respond to both high doses of corticosteroids and oral antifungal agents, 
      with  approximately 60% response rate in both ABPA and SAFS with itraconazole. In 50% of 
      patients itraconazole boosts inhaled corticosteroid exposure, sometimes leading 
      to cushingoid features. Second-line therapy data are scant, but we have shown 
      that 70 to 80% of patients who tolerate either voriconazole or posaconazole also 
      respond. Other useful therapies include nebulized hypertonic saline to aid 
      expectoration of thick sputum and long-term azithromycin for its 
      anti-inflammatory effect on the airways. Omaluzimab is useful in some patients 
      with SAFS and occasionally in ABPA. Complications of ABPA include bronchiectasis, 
      typically central in distribution, and chronic pulmonary aspergillosis. Most 
      patients with ABPA and SAFS can be stabilized for long periods with inhaled 
      corticosteroids and itraconazole or another antifungal agent. Novel 
      immunotherapies are on the horizon.
CI  - (c) Thieme Medical Publishers.
FAU - Hogan, Celia
AU  - Hogan C
AD  - Monsall Unit, Department of Infectious and Tropical Diseases, North Manchester 
      General Hospital, Manchester, UK.
FAU - Denning, David W
AU  - Denning DW
LA  - eng
PT  - Journal Article
PT  - Review
DEP - 20111213
PL  - United States
TA  - Semin Respir Crit Care Med
JT  - Seminars in respiratory and critical care medicine
JID - 9431858
RN  - 0 (Adrenal Cortex Hormones)
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antifungal Agents)
RN  - 37341-29-0 (Immunoglobulin E)
SB  - IM
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Antibodies, Monoclonal/therapeutic use
MH  - Antifungal Agents/therapeutic use
MH  - *Aspergillosis, Allergic Bronchopulmonary/drug 
      therapy/epidemiology/etiology/genetics/physiopathology
MH  - Aspergillus fumigatus/*immunology/pathogenicity
MH  - Asthma/*complications
MH  - Bronchiectasis/complications
MH  - Genetic Predisposition to Disease
MH  - Humans
MH  - Immunoglobulin E/blood
MH  - Skin Tests
EDAT- 2011/12/15 06:00
MHDA- 2012/04/04 06:00
CRDT- 2011/12/15 06:00
PHST- 2011/12/15 06:00 [entrez]
PHST- 2011/12/15 06:00 [pubmed]
PHST- 2012/04/04 06:00 [medline]
AID - 10.1055/s-0031-1295716 [doi]
PST - ppublish
SO  - Semin Respir Crit Care Med. 2011 Dec;32(6):682-92. doi: 10.1055/s-0031-1295716. 
      Epub 2011 Dec 13.