SELECTED ARTICLES FROM THE RECENT LITERATURE 2007 August 14, 2007 When to suspect allergic bronchopulmonary aspergillosis (ABPA) Summary Background – ABPA should be suspected in a patient with persistent asthma (PA) who has certainly additional features. Findings – ABPA was reviewed by Knutsen of St. Louis Univ School of Medicine. ABPA is caused by a sensitivity to Aspergillus fumigatus. ABPA is found predominantly in individuals with PA or cystic fibrosis. Findings include pulmonary infiltrates, markedly elevated serum IgE levels (generally over 1000 IU.ml), IgE and IgA antibodies against A fumigatus, blood and pulmonary eosinophilia and central bronchiectasis. A corner stone of treatment is corticosteroids, often using decreases in the serum IgE level as one marker of therapeutic response. Untreated ABPA frequently leads to extensive bronchiectasis and pulmonary fibrosis with resultant pulmonary insufficiency. Reference J Respir Dis 2006;27:123-34 Editor's Comments As pointed out by the author, ABPA must be distinguished from other Aspergillus-related pulmonary disorders. The pre-existence of PA or cystic fibrosis, pulmonary infiltrates, very high serum IgE levels and eosinophilia should suggest the presence of ABPA. Some patients with ABPA expectorate brownish-green sputum plugs which should be placed in fixative and sectioned for pathologic studies, including fungal stains and possibly immunofluorescence studies to detect Aspergillus hyphae.   © Copyright 1997-2007 American Academy of Allergy, Asthma and Immunology All rights reserved