Asano Koichiro, Oguma Tsuyoshi
Division of Pulmonary Medicine, Department of Medicine, Tokai University School of Medicine, Japan.
Intern Med. 2025 Feb 15;64(4):493-501. doi: 10.2169/internalmedicine.4386-24. Epub 2024 Sep 4.
Allergic bronchopulmonary aspergillosis/mycosis (ABPA/ABPM) is characterized by increased serum levels of total and fungi-specific immunoglobulin E (IgE) and eosinophilic mucus plugs in the airways. Its classification as either an allergic or eosinophilic disease remains controversial. In the present review, we explored this topic based on three clinical studies that analyzed the clinical characteristics of ABPA/ABPM using a cluster analysis, factor analysis, and comparison between ABPM caused by Schizophyllum commune and ABPA. We also compared therapeutic responses to biologics targeting either IgE (omalizumab) or eosinophils (mepolizumab/benralizumab) to elucidate the role of these components in the pathogenesis of ABPA/ABPM. Based on these analyses, eosinophilic mucus plug formation in the airways is considered a cardinal feature of the development of ABPA/ABPM, whereas IgE responses to fungi are important factors that modulate disease manifestation.
变应性支气管肺曲霉病/真菌病（ABPA/ABPM）的特征是血清总免疫球蛋白E（IgE）和真菌特异性IgE水平升高以及气道内嗜酸性黏液栓形成。其作为变应性或嗜酸性疾病的分类仍存在争议。在本综述中，我们基于三项临床研究探讨了这一主题，这些研究使用聚类分析、因子分析以及比较由裂褶菌引起的ABPM和ABPA，分析了ABPA/ABPM的临床特征。我们还比较了针对IgE（奥马珠单抗）或嗜酸性粒细胞（美泊利单抗/贝那利珠单抗）的生物制剂的治疗反应，以阐明这些成分在ABPA/ABPM发病机制中的作用。基于这些分析，气道内嗜酸性黏液栓形成被认为是ABPA/ABPM发生发展的主要特征，而对真菌的IgE反应是调节疾病表现的重要因素。
