Janahi Ibrahim Ahmed, Rehman Abdul, Al-Naimi Amal Rashid
Department of Clinical Pediatrics, Weill Cornell Medical College-Qtar, Doha, Qatar.
Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar.
Ann Thorac Med. 2017 Apr-Jun;12(2):74-82. doi: 10.4103/atm.ATM_231_16.
Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that often occurs in patients with asthma or cystic fibrosis (CF) and is characterized by a hypersensitivity response to the allergens of the fungus . In patients with CF, growth of hyphae within the bronchial lumen triggers an immunoglobulin E (IgE)-mediated hypersensitivity response that results in airway inflammation, bronchospasm, and bronchiectasis. In most published studies, the prevalence of ABPA is about 8.9% in patients with CF. Since the clinical features of this condition overlap significantly with that of CF, ABPA is challenging to diagnose and remains underdiagnosed in many patients. Diagnosis of ABPA in CF patients should be sought in those with evidence of clinical and radiologic deterioration that is not attributable to another etiology, a markedly elevated total serum IgE level (while off steroid therapy) and evidence of sensitization. Management of ABPA involves the use of systemic steroids to reduce inflammation and modulate the immune response. In patients who do not respond to steroids or cannot tolerate them, antifungal agents should be used to reduce the burden of allergens. Recent studies suggest that omalizumab may be an effective option to reduce the frequency of ABPA exacerbations in patients with CF. Further randomized controlled trials are needed to better establish the efficacy of omalizumab in managing patients with CF and ABPA.
变应性支气管肺曲霉病（ABPA）是一种肺部疾病，常发生于哮喘或囊性纤维化（CF）患者中，其特征为对真菌过敏原产生超敏反应。在CF患者中，支气管腔内菌丝生长引发免疫球蛋白E（IgE）介导的超敏反应，导致气道炎症、支气管痉挛和支气管扩张。在大多数已发表的研究中，CF患者中ABPA的患病率约为8.9%。由于这种疾病的临床特征与CF的临床特征显著重叠，ABPA的诊断具有挑战性，许多患者仍未得到诊断。对于CF患者，若有临床和影像学恶化证据且不能归因于其他病因、血清总IgE水平显著升高（在停用类固醇治疗时）以及致敏证据，则应考虑诊断ABPA。ABPA的治疗包括使用全身类固醇以减轻炎症并调节免疫反应。对于对类固醇无反应或无法耐受的患者，应使用抗真菌药物以减轻过敏原负担。最近的研究表明，奥马珠单抗可能是减少CF患者ABPA发作频率的有效选择。需要进一步的随机对照试验，以更好地确定奥马珠单抗在治疗CF和ABPA患者中的疗效。
