Fungal pneumonias. Part 3. Allergic bronchopulmonary aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is receiving increased recognition as a cause of respiratory disease. The clinical, immunologic, and radiologic features of this disease are reviewed with a discussion of possible pathophysiologic mechanisms. One approach to the diagnosis of this disorder incorporates the criteria of bronchospasm, pulmonary infiltrates, skin-test reactivity to and precipitating antibodies against Aspergillus antigen, eosinophilia, elevated IgE levels, and classic bronchographic findings. Steroids appear to be the drug of choice in ABPA, but specific therapeutic regimens will require further long-term studies. The IgE levels may prove to be useful in following the course of this disease and in aiding decisions regarding duration of therapy.