Progressive fungal allergic lung disease, is a common complication of asthma or cystic fibrosis.
Aetiology
- Aspergillus species: Aspergillus fumigatus
- Underlying asthma (2.5% cases) or cystic fibrosis (15% cases)
Clinical features
Episodes of bronchial obstruction with mucous plugs leading to coughing fits, pneumonia, consolidation, wheezing, and breathlessness are typical and central bronchiectasis is a characteristic feature.
- Central bronchiectasis (CHARACTERISTIC)
Diagnosis
Modified ISHAM working group 2013 criteria for diagnosis of ABPA:
- Predisposing asthma/CF
- Obligatory criteria:
- IgE > 1000 IU/mL and
- Positive immediate skin test or increased IgE antibody to Aspergillus
- Supportive (≥2) criteria:
- Eosinophilia > 500
- Precipitins or increased IgG antibody to Aspergillus
- Consistent radiographic opacities
Chest radiograph:
- Finger-in-glove sign (CHARACTERISTIC): Tubular and branching tubular opacities that appear to emanate from the hila, said to resemble gloved fingers
HRCT:
- Halo sign “signet-ring appearance”: Localized ground glass appearance representing an area of hemorrhagic infarction surrounding a nodule (invasive aspergellosis)

Management
- Oral glucocorticosteroids (MAINSTAY, M/effective in acute cases)
- Antifungal agents (chronic use): Ketoconazole, Itraconazole, Voriconazole and posaconazole
- Immunotherapy: Omalizumab (monoclonal antibody to IgE)