Allergic broncho-pulmonary aspergillosis

Clinical immunology: (1) Clinical features


Professor J. Pepys, Department of Clinical Immunology, Institute of Diseases of the Chest, Brompton, Hospital, Fulham Road, London, S.W.3.


In IU out of 143 U.K. patients with pulmonary eosinophilia evidence of allergic broncho-pulmonary aspergillosis was present, consisting of transitory pulmonary shadows, eosinophilia of blood and sputum. Type I and Type HI reactions to prick and intracutaneous tests respectively with A. fumigatus. Precipitins were present in 92% of sera tested with and without concentration. Sputum plugs usually with pulmonary shadows were present in 56% and contained fungal mycelium, and the sputum gave positive cultures in 58%. Characteristic proximal bronchiectasis was present and fibrosis, mainly of the upper lobes, was found in chronic cases. These features were absent in the patients with no evidence of allergy to A. fumigatus.

Patients with early onset of symptoms had a higher atopic status and a much longer interval before pulmonary eosinophilia appeared than those with late onset symptoms. Episodes of pulmonary eosinophilia with aggravation of all symptoms, with fever and positive cultures in 83% for A. fumigatus, were common in the winter months, when there are more spores in the air. Precipitins to one or more of H. influenzae, Str. pneumoniae and Staph. aureus were present in 60% of sputa examined and positive cultures were obtained in 45%, indicating a high incidence of secondary infection.

Increasing airways obstruction with decreasing reversibility was common and some had reduction of CO gas transfer factor. Pulmonary hypertension was uncommon. Corticosteroids reduced sputum plugs, positive cultures and hastened resolution of pulmonary shadows.

Diagnoses such as pneumonia, tuberculosis, bronchiectasis and carcinoma were not uncommonly made before that of allergic broncho-pulmonary aspergillosis.