IV.2.2. Allergic broncho-pulmonary mycosis
Allergic broncho-pulmonary mycosis (ABPM) is probably the most severe
allergic fungal diseases (73). It is typically induced by A.
fumigatus (ABPA), often presents as an asthmatic exacerbation in asthma
or cystic fibrosis patients, and involves an exuberant anti-fungal
allergic response with eosinophilic inflammation and high levels of
total and A.
fumigatus -specific IgE. The IgE response is a major diagnostic
criterion for ABPA, often accompanied by high A.
fumigatus -specific IgG responses as a minor diagnostic criterion, while
the demonstration of A. fumigatus bronchial colonization is
required in some diagnostic scores (87–89).
ABPA natural history consists of sequential flare and remission episodes
leading to irreversible lung damage with central bronchiectasis and
fibrosis if not appropriately treated.