What is allergic pulmonary aspergillosis?

Allergic pulmonary aspergillosis is an allergic reaction to a fungus called aspergillus, which causes inflammation of the airways and air sacs of the lungs. Although most people are frequently exposed to aspergillus, which can grow on dead leaves and other decaying vegetation, infections caused by it, such as a pneumonia or fungus ball (aspergilloma), are rare. Some people, however, have an allergic reaction to this fungus, which is called allergic bronchopulmonary aspergillosis (ABPA). The disease may mimic asthma or pneumonia; in fact, most patients with ABPA have asthma as well.

Symptoms

• Worsening symptoms of asthma
• Wheezing
• Cough may produce brownish plugs or bloody sputum
• Fever

Diagnosis

Exams and tests include:

• Serum IgE antibodies
• Aspergillus antigen skin test
• Serum aspergillus antibodies
• Chest X-ray
• CT scan of the chest
• Sputum stain and culture for fungus
• Bronchoscopy and transbronchial biopsy
• Lung biopsy (rare)

Treatment

Allergic aspergillosis is treated with prednisone. The anti-fungal antibiotic itraconazole can also be helpful. People with asthma should also continue their usual treatments.

Prognosis

The response to therapy is usually good, with improvement over time. Relapses requiring repeat treatment are common.

Prevention

People with predisposing factors like asthma or cystic fibrosis should try to avoid environments where this fungus is found if possible.

Information about this condition, its diagnosis and treatment is provided by physicians, nurses and other clinical staff in the Division of Pulmonary Medicine at Johns Hopkins Children's Center.