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Semin Respir Crit Care Med 2024; 45(01): 114-127
DOI: 10.1055/s-0043-1776912
Review Article

Clinical Manifestation and Treatment of Allergic Bronchopulmonary Aspergillosis

Ritesh Agarwal
1   Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Valliappan Muthu
1   Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
,
Inderpaul S. Sehgal
1   Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
› Author Affiliations Funding R.A. received grant support for conducting research in ABPA from Cipla Pharmaceuticals, Mumbai, India.
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Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to airway colonization by Aspergillus fumigatus in patients with asthma and cystic fibrosis. The pathophysiology of ABPA involves a complex interplay between the fungus and the host immune response, which causes persistent inflammation and tissue damage. Patients present with chronic cough, wheezing, and dyspnea due to uncontrolled asthma. Characteristic symptoms include the expectoration of brownish mucus plugs. Radiographic findings often reveal fleeting pulmonary infiltrates, bronchiectasis, and mucus impaction. However, the definitive diagnosis of ABPA requires a combination of clinical, radiological, and immunological findings. The management of ABPA aims to reduce symptoms, prevent disease progression, and minimize the future risk of exacerbations. The treatment approach involves systemic glucocorticoids or antifungal agents to suppress the inflammatory response or fungal growth and prevent exacerbations. Biological agents may be used in patients with severe disease or glucocorticoid dependence. This review provides an overview of the clinical manifestations and current treatment options for ABPA.

Keywords

allergic fungal airway disease - allergic bronchopulmonary mycosis - ABPM - allergic fungal sensitization - corticosteroids - bronchiectasis


Publication History

Article published online:
28 December 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Agarwal R, Muthu V, Sehgal IS. et al. Prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in adults with bronchial asthma: a systematic review of global data. J Allergy Clin Immunol Pract 2023; 11 (06) 1734-1751.e3
    CrossrefPubMedGoogle Scholar
  • 2 Agarwal R, Muthu V, Sehgal IS. et al. Aspergillus sensitization and allergic bronchopulmonary aspergillosis in asthmatic children: a systematic review and meta-analysis. Diagnostics (Basel) 2023; 13 (05) 922
    CrossrefPubMedGoogle Scholar
  • 3 Soundappan K, Muthu V, Dhooria S. et al. Population prevalence of allergic bronchopulmonary aspergillosis in asthma: an epidemiological study of 43,261 participants from North India. Clin Exp Allergy 2023; 53 (07) 777-780
    CrossrefPubMedGoogle Scholar
  • 4 Saxena S, Madan T, Shah A, Muralidhar K, Sarma PU. Association of polymorphisms in the collagen region of SP-A2 with increased levels of total IgE antibodies and eosinophilia in patients with allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol 2003; 111 (05) 1001-1007
    CrossrefPubMedGoogle Scholar
  • 5 Overton NL, Denning DW, Bowyer P, Simpson A. Genetic susceptibility to allergic bronchopulmonary aspergillosis in asthma: a genetic association study. Allergy Asthma Clin Immunol 2016; 12: 47
    CrossrefPubMedGoogle Scholar
  • 6 Kanaujia R, Arora A, Chakrabarti A, Rudramurthy SM, Agarwal R. Occurrence of cystic fibrosis transmembrane conductance regulator gene mutations in patients with allergic bronchopulmonary aspergillosis complicating asthma. Mycopathologia 2022; 187 (2-3): 147-155
    CrossrefPubMedGoogle Scholar
  • 7 Moss RB, Hsu YP, Olds L. Cytokine dysregulation in activated cystic fibrosis (CF) peripheral lymphocytes. Clin Exp Immunol 2000; 120 (03) 518-525
    CrossrefPubMedGoogle Scholar
  • 8 Lara-Reyna S, Holbrook J, Jarosz-Griffiths HH, Peckham D, McDermott MF. Dysregulated signalling pathways in innate immune cells with cystic fibrosis mutations. Cell Mol Life Sci 2020; 77 (22) 4485-4503
    CrossrefPubMedGoogle Scholar
  • 9 Manti S, Parisi GF, Papale M, Marseglia GL, Licari A, Leonardi S. Type 2 inflammation in cystic fibrosis: new insights. Pediatr Allergy Immunol 2022; 33 (Suppl. 27) 15-17
    CrossrefPubMedGoogle Scholar
  • 10 Kauffman HF. Immunopathogenesis of allergic bronchopulmonary aspergillosis and airway remodeling. Front Biosci 2003; 8: e190-e196
    CrossrefPubMedGoogle Scholar
  • 11 Aimanianda V, Bayry J, Bozza S. et al. Surface hydrophobin prevents immune recognition of airborne fungal spores. Nature 2009; 460 (7259) 1117-1121
    CrossrefPubMedGoogle Scholar
  • 12 Agarwal R, Muthu V, Sehgal IS, Dhooria S, Prasad KT, Aggarwal AN. Allergic bronchopulmonary aspergillosis. Clin Chest Med 2022; 43 (01) 99-125
    CrossrefPubMedGoogle Scholar
  • 13 Tracy MC, Okorie CUA, Foley EA, Moss RB. Allergic bronchopulmonary aspergillosis. J Fungi (Basel) 2016; 2 (02) 17
    CrossrefPubMedGoogle Scholar
  • 14 Kita H. ILC2s and fungal allergy. Allergol Int 2015; 64 (03) 219-226
    CrossrefPubMedGoogle Scholar
  • 15 Persson EK, Verstraete K, Heyndrickx I. et al. Protein crystallization promotes type 2 immunity and is reversible by antibody treatment. Science 2019; 364 (6442) 364
    CrossrefPubMedGoogle Scholar
  • 16 Muniz VS, Silva JC, Braga YAV. et al. Eosinophils release extracellular DNA traps in response to Aspergillus fumigatus . J Allergy Clin Immunol 2018; 141 (02) 571-585.e7
    CrossrefPubMedGoogle Scholar
  • 17 Agarwal R, Gupta D, Aggarwal AN, Saxena AK, Chakrabarti A, Jindal SK. Clinical significance of hyperattenuating mucoid impaction in allergic bronchopulmonary aspergillosis: an analysis of 155 patients. Chest 2007; 132 (04) 1183-1190
    CrossrefPubMedGoogle Scholar
  • 18 Agarwal R, Gupta D, Aggarwal AN. et al. Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis. Respir Med 2010; 104 (02) 204-210
    CrossrefPubMedGoogle Scholar
  • 19 Campbell MJ, Clayton YM. Bronchopulmonary aspergillosis. A correlation of the clinical and laboratory findings in 272 patients investigated for bronchopulmonary aspergillosis. Am Rev Respir Dis 1964; 89: 186-196
    PubMedGoogle Scholar
  • 20 Godet C, Couturaud F, Marchand-Adam S. et al; NebuLamB study group and GREPI network. Nebulised liposomal amphotericin-B as maintenance therapy in allergic bronchopulmonary aspergillosis: a randomised, multicentre trial. Eur Respir J 2022; 59 (06) 2102218
    CrossrefPubMedGoogle Scholar
  • 21 Khan ZU, Sandhu RS, Randhawa HS, Menon MP, Dusaj IS. Allergic bronchopulmonary aspergillosis: a study of 46 cases with special reference to laboratory aspects. Scand J Respir Dis 1976; 57 (02) 73-87
    PubMedGoogle Scholar
  • 22 Kumar R, Gaur SN. Prevalence of allergic bronchopulmonary aspergillosis in patients with bronchial asthma. Asian Pac J Allergy Immunol 2000; 18 (04) 181-185
    PubMedGoogle Scholar
  • 23 Muthu V, Sehgal IS, Prasad KT. et al. Epidemiology and outcomes of allergic bronchopulmonary aspergillosis in the elderly. Mycoses 2022; 65 (01) 71-78
    CrossrefPubMedGoogle Scholar
  • 24 Oguma T, Taniguchi M, Shimoda T. et al. Allergic bronchopulmonary aspergillosis in Japan: a nationwide survey. Allergol Int 2018; 67 (01) 79-84
    CrossrefPubMedGoogle Scholar
  • 25 Shahul A, Govindaraj V, Kumar SV. et al. Allergic bronchopulmonary aspergillosis in acute severe asthma - a cross-sectional study. J Clin Diagn Res 2020; 14: OC12-OC15
    PubMedGoogle Scholar
  • 26 Zeng Y, Xue X, Cai H. et al. Clinical characteristics and prognosis of allergic bronchopulmonary aspergillosis: a retrospective cohort study. J Asthma Allergy 2022; 15: 53-62
    CrossrefPubMedGoogle Scholar
  • 27 Zhang C, Jiang Z, Shao C. Clinical characteristics of allergic bronchopulmonary aspergillosis. Clin Respir J 2020; 14 (05) 440-446
    CrossrefPubMedGoogle Scholar
  • 28 Muthu V, Sehgal IS, Prasad KT. et al. Allergic bronchopulmonary aspergillosis (ABPA) sans asthma: a distinct subset of ABPA with a lesser risk of exacerbation. Med Mycol 2020; 58 (02) 260-263
    PubMedGoogle Scholar
  • 29 Benkalfate N, Dirou S, Germaud P. et al. Total unilateral pulmonary collapse secondary to allergic bronchopulmonary aspergillosis: a case series of an unusual cause of complete atelectasis. BMC Pulm Med 2021; 21 (01) 425
    CrossrefPubMedGoogle Scholar
  • 30 Agarwal R, Aggarwal AN, Gupta N, Gupta D. A rare cause of acute respiratory failure–allergic bronchopulmonary aspergillosis. Mycoses 2011; 54 (04) e223-e227
    CrossrefPubMedGoogle Scholar
  • 31 Agarwal R, Singh N, Gupta D. Pulmonary hypertension as a presenting manifestation of allergic bronchopulmonary aspergillosis. Indian J Chest Dis Allied Sci 2009; 51 (01) 37-40
    PubMedGoogle Scholar
  • 32 Sehgal IS, Dhooria S, Bal A, Agarwal R. Allergic bronchopulmonary aspergillosis in an adult with Kartagener syndrome. BMJ Case Rep 2015; 2015: bcr2015211493
    CrossrefPubMedGoogle Scholar
  • 33 Sehgal IS, Agarwal R. Specific IgE is better than skin testing for detecting Aspergillus sensitization and allergic bronchopulmonary aspergillosis in asthma. Chest 2015; 147 (05) e194
    CrossrefPubMedGoogle Scholar
  • 34 Lee PH, Carr DH, Rubens MB, Cole P, Hansell DM. Accuracy of CT in predicting the cause of bronchiectasis. Clin Radiol 1995; 50 (12) 839-841
    CrossrefPubMedGoogle Scholar
  • 35 Reiff DB, Wells AU, Carr DH, Cole PJ, Hansell DM. CT findings in bronchiectasis: limited value in distinguishing between idiopathic and specific types. AJR Am J Roentgenol 1995; 165 (02) 261-267
    CrossrefPubMedGoogle Scholar
  • 36 Cartier Y, Kavanagh PV, Johkoh T, Mason AC, Müller NL. Bronchiectasis: accuracy of high-resolution CT in the differentiation of specific diseases. AJR Am J Roentgenol 1999; 173 (01) 47-52
    CrossrefPubMedGoogle Scholar
  • 37 Agarwal R, Maskey D, Aggarwal AN. et al. Diagnostic performance of various tests and criteria employed in allergic bronchopulmonary aspergillosis: a latent class analysis. PLoS One 2013; 8 (04) e61105
    CrossrefPubMedGoogle Scholar
  • 38 Saxena P, Choudhary H, Muthu V. et al. Which are the optimal criteria for the diagnosis of allergic bronchopulmonary aspergillosis? A latent class analysis. J Allergy Clin Immunol Pract 2021; 9 (01) 328-335.e1
    CrossrefPubMedGoogle Scholar
  • 39 Muthu V, Sehgal IS, Dhooria S, Aggarwal AN, Agarwal R. Utility of recombinant Aspergillus fumigatus antigens in the diagnosis of allergic bronchopulmonary aspergillosis: a systematic review and diagnostic test accuracy meta-analysis. Clin Exp Allergy 2018; 48 (09) 1107-1136
    CrossrefPubMedGoogle Scholar
  • 40 Muthu V, Singh P, Choudhary H. et al. Role of recombinant Aspergillus fumigatus antigens in diagnosing Aspergillus sensitisation among asthmatics. Mycoses 2020; 63 (09) 928-936
    CrossrefPubMedGoogle Scholar
  • 41 Canonica GW, Ansotegui IJ, Pawankar R. et al; WAO-ARIA-GA2LEN Task Force: Katrina Allen, Riccardo Asero, Barbara Bohle, Linda Cox, Frederic de Blay, Motohiro Ebisawa, Rene Maximiliano-Gomez, Sandra Gonzalez-Diaz, Tari Haahtela, Stephen Holgate, Thilo Jakob, Mark Larche, Paolo Maria Matricardi, John Oppenheimer, Lars K Poulsen, Harald E Renz, Nelson Rosario, Marc Rothenberg, Mario Sanchez-Borges, Enrico Scala, Rudolf Valenta. A WAO - ARIA - GA2LEN consensus document on molecular-based allergy diagnostics. World Allergy Organ J 2013; 6 (01) 17
    CrossrefPubMedGoogle Scholar
  • 42 Pomés A, Davies JM, Gadermaier G. et al; WHO IUIS Allergen Nomenclature Sub-Committee. WHO/IUIS allergen nomenclature: providing a common language. Mol Immunol 2018; 100: 3-13
    CrossrefPubMedGoogle Scholar
  • 43 Fukutomi Y, Taniguchi M. Sensitization to fungal allergens: resolved and unresolved issues. Allergol Int 2015; 64 (04) 321-331
    CrossrefPubMedGoogle Scholar
  • 44 Fukutomi Y, Tanimoto H, Yasueda H, Taniguchi M. Serological diagnosis of allergic bronchopulmonary mycosis: progress and challenges. Allergol Int 2016; 65 (01) 30-36
    CrossrefPubMedGoogle Scholar
  • 45 Muthu V, Singh P, Choudhary H. et al. Diagnostic cutoffs and clinical utility of recombinant Aspergillus fumigatus antigens in the diagnosis of allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract 2020; 8 (02) 579-587
    CrossrefPubMedGoogle Scholar
  • 46 Polverino E, Goeminne PC, McDonnell MJ. et al. European Respiratory Society guidelines for the management of adult bronchiectasis. Eur Respir J 2017; 50 (03) 1700629
    CrossrefPubMedGoogle Scholar
  • 47 Sehgal IS, Dhooria S, Bal A. et al. A young girl with bronchiectasis and elevated sweat chloride. Chest 2021; 159 (03) e155-e158
    CrossrefPubMedGoogle Scholar
  • 48 Matsuse H, Tsuchida T, Fukahori S. et al. Dissociation between sensitizing and colonizing fungi in patients with allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol 2013; 111 (03) 190-193
    CrossrefPubMedGoogle Scholar
  • 49 Asano K, Hebisawa A, Ishiguro T. et al; Japan ABPM Research Program. New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation. J Allergy Clin Immunol 2021; 147 (04) 1261-1268.e5
    CrossrefPubMedGoogle Scholar
  • 50 Meis JF, Chowdhary A, Rhodes JL, Fisher MC, Verweij PE. Clinical implications of globally emerging azole resistance in Aspergillus fumigatus . Philos Trans R Soc Lond B Biol Sci 2016; 371 (1709) 371
    PubMedGoogle Scholar
  • 51 Agarwal R, Aggarwal AN, Sehgal IS, Dhooria S, Behera D, Chakrabarti A. Performance of serum galactomannan in patients with allergic bronchopulmonary aspergillosis. Mycoses 2015; 58 (07) 408-412
    CrossrefPubMedGoogle Scholar
  • 52 Agarwal R, Sehgal IS, Muthu V, Dhooria S, Prasad KT, Aggarwal AN. Estimating the minimal important difference in FEV1 for patients with allergic bronchopulmonary aspergillosis. Eur Respir J 2022; 60 (04) 2201242
    CrossrefPubMedGoogle Scholar
  • 53 Agarwal R, Khan A, Garg M, Aggarwal AN, Gupta D. Pictorial essay: allergic bronchopulmonary aspergillosis. Indian J Radiol Imaging 2011; 21 (04) 242-252
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Agarwal R, Khan A, Garg M, Aggarwal AN, Gupta D. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis. World J Radiol 2012; 4 (04) 141-150
    CrossrefPubMedGoogle Scholar
  • 55 Agarwal R, Khan A, Gupta D, Aggarwal AN, Saxena AK, Chakrabarti A. An alternate method of classifying allergic bronchopulmonary aspergillosis based on high-attenuation mucus. PLoS One 2010; 5 (12) e15346
    CrossrefPubMedGoogle Scholar
  • 56 Phuyal S, Garg MK, Agarwal R. et al. High-attenuation mucus impaction in patients with allergic bronchopulmonary aspergillosis: objective criteria on high-resolution computed tomography and correlation with serologic parameters. Curr Probl Diagn Radiol 2016; 45 (03) 168-173
    CrossrefPubMedGoogle Scholar
  • 57 Agarwal R. Allergic bronchopulmonary aspergillosis: lessons for the busy radiologist. World J Radiol 2011; 3 (07) 178-181
    CrossrefPubMedGoogle Scholar
  • 58 Sodhi KS, Gupta P, Shrivastav A. et al. Evaluation of 3 T lung magnetic resonance imaging in children with allergic bronchopulmonary aspergillosis: pilot study. Eur J Radiol 2019; 111: 88-92
    CrossrefPubMedGoogle Scholar
  • 59 Rosenberg M, Patterson R, Mintzer R, Cooper BJ, Roberts M, Harris KE. Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med 1977; 86 (04) 405-414
    CrossrefPubMedGoogle Scholar
  • 60 Agarwal R, Chakrabarti A, Shah A. et al; ABPA complicating asthma ISHAM working group. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy 2013; 43 (08) 850-873
    CrossrefPubMedGoogle Scholar
  • 61 Stevens DA, Schwartz HJ, Lee JY. et al. A randomized trial of itraconazole in allergic bronchopulmonary aspergillosis. N Engl J Med 2000; 342 (11) 756-762
    CrossrefPubMedGoogle Scholar
  • 62 Wark PA, Hensley MJ, Saltos N. et al. Anti-inflammatory effect of itraconazole in stable allergic bronchopulmonary aspergillosis: a randomized controlled trial. J Allergy Clin Immunol 2003; 111 (05) 952-957
    CrossrefPubMedGoogle Scholar
  • 63 Agarwal R, Aggarwal AN, Dhooria S. et al. A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J 2016; 47 (02) 490-498
    CrossrefPubMedGoogle Scholar
  • 64 Agarwal R, Dhooria S, Singh Sehgal I. et al. A randomized trial of itraconazole vs prednisolone in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Chest 2018; 153 (03) 656-664
    CrossrefPubMedGoogle Scholar
  • 65 Agarwal R, Dhooria S, Sehgal IS. et al. A randomised trial of voriconazole and prednisolone monotherapy in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J 2018; 52 (03) 1801159
    CrossrefPubMedGoogle Scholar
  • 66 Agarwal R, Muthu V, Sehgal IS. et al. A randomised trial of prednisolone versus prednisolone and itraconazole in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Eur Respir J 2021; 59 (04) 2101787
    CrossrefPubMedGoogle Scholar
  • 67 Currie DC, Lueck C, Milburn HJ. et al. Controlled trial of natamycin in the treatment of allergic bronchopulmonary aspergillosis. Thorax 1990; 45 (06) 447-450
    CrossrefPubMedGoogle Scholar
  • 68 Ram B, Aggarwal AN, Dhooria S. et al. A pilot randomized trial of nebulized amphotericin in patients with allergic bronchopulmonary aspergillosis. J Asthma 2016; 53 (05) 517-524
    CrossrefPubMedGoogle Scholar
  • 69 Voskamp AL, Gillman A, Symons K. et al. Clinical efficacy and immunologic effects of omalizumab in allergic bronchopulmonary aspergillosis. J Allergy Clin Immunol Pract 2015; 3 (02) 192-199
    CrossrefPubMedGoogle Scholar
  • 70 Dodamani MH, Muthu V, Thakur R. et al. A randomised trial of vitamin D in acute-stage allergic bronchopulmonary aspergillosis complicating asthma. Mycoses 2019; 62 (04) 320-327
    CrossrefPubMedGoogle Scholar
  • 71 [Anonymous] Study to evaluate itraconazole administered as inhaled dry powder in adults with asthma and allergic bronchopulmonary aspergillosis. Accessed July 4, 2023 at: https://clinicaltrials.gov/ct2/show/NCT05667662
    PubMedGoogle Scholar
  • 72 Jin M, Douglass JA, Elborn JS. et al. Omalizumab in allergic bronchopulmonary aspergillosis: a systematic review and meta-analysis. J Allergy Clin Immunol Pract 2023; 11 (03) 896-905
    CrossrefPubMedGoogle Scholar
  • 73 Abbotsford J, Foley DA, Goff Z, Bowen AC, Blyth CC, Yeoh DK. Clinical experience with SUBA-itraconazole at a tertiary paediatric hospital. J Antimicrob Chemother 2021; 76 (01) 249-252
    CrossrefPubMedGoogle Scholar
  • 74 Maturu VN, Agarwal R. Acute invasive pulmonary aspergillosis complicating allergic bronchopulmonary aspergillosis: case report and systematic review. Mycopathologia 2015; 180 (3-4): 209-215
    CrossrefPubMedGoogle Scholar
  • 75 Cohen-Cymberknoh M, Blau H, Shoseyov D. et al. Intravenous monthly pulse methylprednisolone treatment for ABPA in patients with cystic fibrosis. J Cyst Fibros 2009; 8 (04) 253-257
    CrossrefPubMedGoogle Scholar
  • 76 Singh Sehgal I, Agarwal R. Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations. Eur Respir Rev 2014; 23 (131) 149-152
    CrossrefPubMedGoogle Scholar
  • 77 Dhooria S, Agarwal R. Diagnosis of allergic bronchopulmonary aspergillosis: a case-based approach. Future Microbiol 2014; 9 (10) 1195-1208
    CrossrefPubMedGoogle Scholar
  • 78 Agarwal R, Khan A, Aggarwal AN, Saikia B, Gupta D, Chakrabarti A. Role of inhaled corticosteroids in the management of serological allergic bronchopulmonary aspergillosis (ABPA). Intern Med 2011; 50 (08) 855-860
    CrossrefPubMedGoogle Scholar
  • 79 Laska IF, Crichton ML, Shoemark A, Chalmers JD. The efficacy and safety of inhaled antibiotics for the treatment of bronchiectasis in adults: a systematic review and meta-analysis. Lancet Respir Med 2019; 7 (10) 855-869
    CrossrefPubMedGoogle Scholar
  • 80 Sehgal IS, Agarwal R. Role of inhaled amphotericin in allergic bronchopulmonary aspergillosis. J Postgrad Med 2014; 60 (01) 41-45
    CrossrefPubMedGoogle Scholar
  • 81 Muthu V, Dhooria S, Sehgal IS. et al. Nebulized amphotericin B for preventing exacerbations in allergic bronchopulmonary aspergillosis: a systematic review and meta-analysis. Pulm Pharmacol Ther 2023; 81: 102226
    CrossrefPubMedGoogle Scholar
  • 82 Moss RB. Severe fungal asthma: a role for biologics and inhaled antifungals. J Fungi (Basel) 2023; 9 (01) 85
    CrossrefPubMedGoogle Scholar
  • 83 Nair P, Wenzel S, Rabe KF. et al; ZONDA Trial Investigators. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med 2017; 376 (25) 2448-2458
    CrossrefPubMedGoogle Scholar
  • 84 Schleich F, Vaia ES, Pilette C. et al. Mepolizumab for allergic bronchopulmonary aspergillosis: report of 20 cases from the Belgian Severe Asthma Registry and review of the literature. J Allergy Clin Immunol Pract 2020; 8 (07) 2412-2413.e2
    CrossrefPubMedGoogle Scholar
  • 85 Caminati M, Batani V, Guidolin L, Festi G, Senna G. One-year mepolizumab for allergic bronchopulmonary aspergillosis: focus on steroid sparing effect and markers of response. Eur J Intern Med 2022; 99: 112-115
    CrossrefPubMedGoogle Scholar
  • 86 Soeda S, Kono Y, Tsuzuki R. et al. Allergic bronchopulmonary aspergillosis successfully treated with benralizumab. J Allergy Clin Immunol Pract 2019; 7 (05) 1633-1635
    CrossrefPubMedGoogle Scholar
  • 87 Matsuura H, Fujiwara K, Omori H. et al. Successful treatment with benralizumab for allergic bronchopulmonary aspergillosis that developed after disastrous heavy rainfall in western Japan. Intern Med 2021; 60 (09) 1443-1450
    CrossrefPubMedGoogle Scholar
  • 88 Ramonell RP, Lee FE, Swenson C, Kuruvilla M. Dupilumab treatment for allergic bronchopulmonary aspergillosis: a case series. J Allergy Clin Immunol Pract 2020; 8 (02) 742-743
    CrossrefPubMedGoogle Scholar
  • 89 Eldaabossi SAM, Awad A, Anshasi N. Mepolizumab and dupilumab as a replacement to systemic glucocorticoids for the treatment of chronic eosinophilic pneumonia and allergic bronchopulmonary aspergillosis - case series, Almoosa specialist hospital. Respir Med Case Rep 2021; 34: 101520
    PubMedGoogle Scholar
  • 90 Tashiro H, Takahashi K, Kurihara Y, Sadamatsu H, Kimura S, Sueoka-Aragane N. Efficacy of dupilumab and biomarkers for systemic corticosteroid naïve allergic bronchopulmonary mycosis. Allergol Int 2021; 70 (01) 145-147
    CrossrefPubMedGoogle Scholar
  • 91 Agarwal R, Muthu V. Benralizumab as a first-line treatment for ABPA: is it really indicated?. Intern Med 2021; 60 (15) 2519
    CrossrefPubMedGoogle Scholar
  • 92 Schelstraete P, Van Daele S, Haerynck F. et al. Voriconazole treatment in CF patients with ABPA and/or invasive aspergillosis. J Cyst Fibros 2010; 9: S53
    CrossrefPubMedGoogle Scholar
  • 93 Hatziagorou E, Avramidou V, Botskarieva S. et al. Effectiveness of omalizumab for treatment of allergic bronchopulmonary aspergillosis (ABPA) among children and adolescents with cystic fibrosis. J Cyst Fibros 2012; 11: S147
    CrossrefPubMedGoogle Scholar
  • 94 Wright M, Cho E, Yang C. Omalizumab therapy for steroid-dependent ABPA in children with cystic fibrosis: a case series. J Cyst Fibros 2016; 15: S47
    CrossrefPubMedGoogle Scholar
  • 95 Mathew JL, Kumar K, Agrawal S. et al. Evidence-based guidelines for the management of allergic bronchopulmonary aspergillosis (ABPA) in children and adolescents with asthma. Indian J Pediatr 2023; 90 (07) 708-717
    CrossrefPubMedGoogle Scholar
  • 96 Chowdhary A, Agarwal K, Kathuria S, Gaur SN, Randhawa HS, Meis JF. Allergic bronchopulmonary mycosis due to fungi other than Aspergillus: a global overview. Crit Rev Microbiol 2014; 40 (01) 30-48
    CrossrefPubMedGoogle Scholar
  • 97 Sehgal IS, Dhooria S, Thurai Prasad K. et al. Pregnancy complicated by allergic bronchopulmonary aspergillosis: a case-control study. Mycoses 2021; 64 (01) 35-41
    CrossrefPubMedGoogle Scholar
  • 98 De Santis M, Di Gianantonio E, Cesari E, Ambrosini G, Straface G, Clementi M. First-trimester itraconazole exposure and pregnancy outcome: a prospective cohort study of women contacting teratology information services in Italy. Drug Saf 2009; 32 (03) 239-244
    CrossrefPubMedGoogle Scholar
  • 99 Namazy J, Cabana MD, Scheuerle AE. et al. The Xolair Pregnancy Registry (EXPECT): the safety of omalizumab use during pregnancy. J Allergy Clin Immunol 2015; 135 (02) 407-412
    CrossrefPubMedGoogle Scholar