ABPA is a disease state induced by arthus reaction to colonizing
aspergillus in the bronchi in patients with bronchial asthma.
- ABPA should be suspected whenever asthma is refractory and is
associated with fever, cough and black or grey sputum.
- Chest x-ray often reveals evanescent pulmonary infiltrates.
- Marked eosinophilia and elevated IgE are noted.
- Aspergillus colonizes in the bronchi in asthmatics because of thick secretions. A
precipitating antibody is produced. A type III immunological reaction
follows. Complement is activated. An inflammatory response occurs with
damage to the bronchial wall and the bronchi get plugged with secretion. Segmental
infiltrates and atelectasis follows.
- Aspergillus precipitating antibody is detected in serum.
- IgE levels and eosinophiles are elevated.
- Central bronchiectasis can be demonstrated by CT scan.
- ABPA responds to systemic steroids.
- Dose and duration of steroids can be adjusted by following serum IgE levels.