Allergic Bronchopulmonary Aspergillosis, Allergic Aspergillus Sinusitis and their Co-occurrence

Diwakar, Amit; Panjabi, Chandramani; Shah, Ashok

doi:10.2174/1874838400801010052

Cited by 3 publications

(3 citation statements)

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“…Tenacious secretions within the bronchi of some patients, usually asthmatics, provide a hospitable environment for the growth of fungi. The subsequent release of antigenic fungal material sets into motion a host of immunological reactions culminating in pulmonary damage [ 53 ]. Usually the disease process manifests as a type I (IgE mediated) hypersensitivity response, but type III (IgG mediated immune complexes) and type IV (cell mediated) reactions have also been noted.…”

Section: Introductionmentioning

confidence: 99%

Allergic Aspergillus sinusitis and its association with allergic bronchopulmonary aspergillosis

Panjabi

Shah

2011

Asia Pacific Allergy

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Allergic Aspergillus sinusitis (AAS) is a three decade old clinicopathologic entity in which mucoid impaction akin to that of allergic bronchopulmonary aspergillosis (ABPA) occurs in the paranasal sinuses. Features such as radiographic evidence of pansinusitis, passage of nasal plugs and recurrent nasal polyposis in patients with an atopic background is suggestive of AAS. Histopathlogic confirmation from the inspissated mucus is a sine qua non for the diagnosis. Heterogeneous densities on computed tomography of the paranasal sinuses are caused by the 'allergic mucin' in the sinuses. Many patients give a history of having undergone multiple surgical procedures for symptomatic relief. The current approach to treatment appears to include an initial surgical debridement followed by postoperative oral corticosteroids for long durations. Although both ABPA and AAS are classified as Aspergillus-related hypersensitivity respiratory disorders, their co-occurrence appears to be an infrequently recognised phenomenon. This could perhaps be attributed to the fact that these two diseases are often treated by two different specialties. A high index of suspicion is required to establish the diagnoses of ABPA and AAS. All patients with asthma and/or rhinosinusitis along with sensitisation to Aspergillus antigens are at an increased risk of developing ABPA and/or AAS. ABPA must be excluded in all patients with AAS and vice versa. Early diagnosis and initiation of appropriate therapy could plausibly alter the course of the disease processes and prevent the possible development of long term sequelae.

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Section: Introductionmentioning

confidence: 99%

Allergic Aspergillus sinusitis and its association with allergic bronchopulmonary aspergillosis

Panjabi

Shah

2011

Asia Pacific Allergy

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“…The occurrence of other Aspergillus -related hypersensitivity respiratory disorders must be sought for in all patients with ABPA. 127 128 …”

Section: Discussionmentioning

confidence: 99%

Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity

Shah

Panjabi

2016

Allergy Asthma Immunol Res

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In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in the diagnosis and monitoring of the disease. Demonstration of central bronchiectasis with normal tapering bronchi is still considered pathognomonic in patients without CF. Elevated serum IgE levels and Aspergillus-specific IgE and/or IgG are also vital for the diagnosis. Mucoid impaction occurring in the paranasal sinuses results in AAS, which also requires a set of diagnostic criteria. Demonstration of fungal elements in sinus material is the hallmark of AAS. In spite of similar histopathologic features, co-existence of ABPA and AAS is still uncommon. Oral corticosteroids continue to be the mainstay of management of allergic aspergillosis. Antifungal agents play an adjunctive role in ABPA as they help reduce the fungal load. Saprophytic colonization in cavitary ABPA may lead to aspergilloma formation, which could increase the severity of the disease. The presence of ABPA, AAS, and aspergilloma in the same patient has also been documented. All patients with Aspergillus-sensitized asthma must be screened for ABPA, and AAS should always be looked for.

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“…Since asthma and sinusitis are often seen by two different specialties, the occurrence of AAS in ABPA and of ABPA in AAS may easily be overlooked [186,205]. There was no mention of concomitant ABPA in a series of 44 patients with AFS from the Mayo Clinic (Rochester, MN, USA) [206].…”

Section: Allergic Aspergillus Sinusitismentioning

confidence: 99%