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Allergic Pulmonary Aspergillosis

written by: DaniellaNicole • edited by: Leigh A. Zaykoski • updated: 8/26/2010

Patients with asthma and cystic fibrosis need to be especially careful around dry leaves, stored grains and bird droppings as these locations can harbor the fungus that can cause allergic pulmonary aspergillosis.

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    Allergic pulmonary aspergillosis is the name given to an allergic reaction to the aspergillus fungus. This reaction results in the air sacs of the lungs and the airways to become inflamed. This is also known by other names such as allergic bronchopulmonary aspergillosis (ABPA) and aspergillosis – allergic bronchopulmonary.

    Patients with conditions such as cystic fibrosis and asthma are at the highest risk for experiencing this allergic reaction. The prognosis is good, as patients usually get better over time with treatment, though relapses are common. Such relapses may require additional treatment.

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    Signs and Symptoms

    The symptoms of allergic bronchopulmonary aspergillosis (ABPA) include the following:

    • Asthma symptoms may worsen
    • Fever
    • Weakness
    • Bloody sputum or brown colored plugs produced by coughing
    • Wheezing

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    Diagnosis

    There are multiple ways to effectively diagnose this allergic reaction in patients. These methods include:

    • Skin test (aspergillus antigen)
    • Bronchoscopy and transbronchial biopsy
    • Chest x-ray
    • Sputum stain and culture for fungus
    • CBC with peripheral eosinophil count
    • Serum aspergillus antibodies
    • Serum IgG and IgE antibodies
    • Chest CT scan
    • Lung biopsy (rarely used)

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    Treatment

    Corticosteroids such as prednisone are used to treat ABPA. Itraconazole, an antifungal antibiotic, is also sometimes used. Patients with adequate pulmonary reserve and massive haemoptysis may be considered for surgical treatment, though the need for this is not common.

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    Prevention

    Rarely occurring in those with a normal immune system, those with a weakened immune system, asthma, cystic fibrosis and other conditions that would put them at risk should avoid those places where the aspergillus fungus is found. Such places include stored grain, dead leaves, compost stacks, bird droppings and any place where vegetation in a state of decay may be found.

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    Resources:

    Pulmonary aspergillosis – allergic bronchopulmonary type. U.S. National Library of Medicine - National Institutes of Health. Updated by Sean O Stitham, MD, Jatin M. Vyas, MD, PhD. Reviewed by VeriMed Healthcare Network and David Zieve, MD, MHA. Updated 5/19/2008. http://www.nlm.nih.gov/medlineplus/ency/article/000070.htm

    Allergic broncho-pulmonary aspergillosis with aspergilloma developing in a cane sugar mill worker. R. Prasad MD, FAMS, Rajiv Garg, Sanjay, A.D. Shukla. Last modified February 13, 2009. The Internet Journal of Pulmonary Medicine. http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijpm/vol9n1/aspergillosis.xml