IV.2.2. Allergic broncho-pulmonary mycosis
Allergic broncho-pulmonary mycosis (ABPM) is probably the most severe allergic fungal diseases (73). It is typically induced by A. fumigatus (ABPA), often presents as an asthmatic exacerbation in asthma or cystic fibrosis patients, and involves an exuberant anti-fungal allergic response with eosinophilic inflammation and high levels of total and A. fumigatus -specific IgE. The IgE response is a major diagnostic criterion for ABPA, often accompanied by high A. fumigatus -specific IgG responses as a minor diagnostic criterion, while the demonstration of A. fumigatus bronchial colonization is required in some diagnostic scores (87–89).
ABPA natural history consists of sequential flare and remission episodes leading to irreversible lung damage with central bronchiectasis and fibrosis if not appropriately treated.