Allergic Bronchopulmonary Aspergillosis/Mycosis: An Allergic Disease or an Eosinophilic Disease?

Overview

Journal Intern Med

Specialty General Medicine

Date 2024 Sep 4

PMID 39231658

Authors

Koichiro Asano

Tsuyoshi Oguma

Affiliations

Soon will be listed here.

Abstract

Allergic bronchopulmonary aspergillosis/mycosis (ABPA/ABPM) is characterized by increased serum levels of total and fungi-specific immunoglobulin E (IgE) and eosinophilic mucus plugs in the airways. Its classification as either an allergic or eosinophilic disease remains controversial. In the present review, we explored this topic based on three clinical studies that analyzed the clinical characteristics of ABPA/ABPM using a cluster analysis, factor analysis, and comparison between ABPM caused by Schizophyllum commune and ABPA. We also compared therapeutic responses to biologics targeting either IgE (omalizumab) or eosinophils (mepolizumab/benralizumab) to elucidate the role of these components in the pathogenesis of ABPA/ABPM. Based on these analyses, eosinophilic mucus plug formation in the airways is considered a cardinal feature of the development of ABPA/ABPM, whereas IgE responses to fungi are important factors that modulate disease manifestation.

References

Wardlaw A . Allergic Fungal Airway Disease Is a Distinct Endotype of Difficult-to-Treat Asthma. J Allergy Clin Immunol Pract. 2021; 9(12):4268-4269. DOI: 10.1016/j.jaip.2021.10.007. View

Crofton J, Livingstone J, OSWALD N, ROBERTS A . Pulmonary eosinophilia. Thorax. 1952; 7(1):1-35. PMC: 1019138. DOI: 10.1136/thx.7.1.1. View

Haldar P, Pavord I, Shaw D, Berry M, Thomas M, Brightling C . Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med. 2008; 178(3):218-224. PMC: 3992366. DOI: 10.1164/rccm.200711-1754OC. View

Mikura S, Saraya T, Yoshida Y, Oda M, Ishida M, Honda K . Successful Treatment of Mepolizumab- and Prednisolone-resistant Allergic Bronchopulmonary Aspergillosis with Dupilumab. Intern Med. 2021; 60(17):2839-2842. PMC: 8479224. DOI: 10.2169/internalmedicine.6679-20. View

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. 2020; 70(1):145-147. DOI: 10.1016/j.alit.2020.08.006. View

Oguma T, Ishiguro T, Kamei K, Tanaka J, Suzuki J, Hebisawa A . Clinical characteristics of allergic bronchopulmonary mycosis caused by Schizophyllum commune. Clin Transl Allergy. 2024; 14(1):e12327. PMC: 10758016. DOI: 10.1002/clt2.12327. View

Tillie-Leblond I, Germaud P, Leroyer C, Tetu L, Girard F, Devouassoux G . Allergic bronchopulmonary aspergillosis and omalizumab. Allergy. 2011; 66(9):1254-6. DOI: 10.1111/j.1398-9995.2011.02599.x. View

Ogata H, Sha K, Kotetsu Y, Enokizu-Ogawa A, Katahira K, Ishimatsu A . Tezepelumab treatment for allergic bronchopulmonary aspergillosis. Respirol Case Rep. 2023; 11(5):e01147. PMC: 10111631. DOI: 10.1002/rcr2.1147. View

Dhariwal J, Hearn A, Kavanagh J, dAncona G, Green L, Fernandes M . Real-World Effectiveness of Anti-IL-5/5R Therapy in Severe Atopic Eosinophilic Asthma with Fungal Sensitization. J Allergy Clin Immunol Pract. 2021; 9(6):2315-2320.e1. DOI: 10.1016/j.jaip.2021.02.048. View

10.

Jin M, Douglass J, Elborn J, Agarwal R, Calhoun W, Lazarewicz S . Omalizumab in Allergic Bronchopulmonary Aspergillosis: A Systematic Review and Meta-Analysis. J Allergy Clin Immunol Pract. 2022; 11(3):896-905. DOI: 10.1016/j.jaip.2022.12.012. View

11.

Muniz V, Silva J, Braga Y, Melo R, Ueki S, Takeda M . Eosinophils release extracellular DNA traps in response to Aspergillus fumigatus. J Allergy Clin Immunol. 2017; 141(2):571-585.e7. DOI: 10.1016/j.jaci.2017.07.048. View

12.

Okada N, Yamamoto Y, Oguma T, Tanaka J, Tomomatsu K, Shiraishi Y . Allergic bronchopulmonary aspergillosis with atopic, nonatopic, and sans asthma-Factor analysis. Allergy. 2023; 78(11):2933-2943. DOI: 10.1111/all.15820. View

13.

Ramonell R, Lee F, Swenson C, Kuruvilla M . Dupilumab treatment for allergic bronchopulmonary aspergillosis: A case series. J Allergy Clin Immunol Pract. 2019; 8(2):742-743. PMC: 9161156. DOI: 10.1016/j.jaip.2019.11.031. View

14.

Kawasaki Y, Nishiki K, Ishizaki T . Successful treatment with dupilumab in mepolizumab-resistant allergic bronchopulmonary aspergillosis. Respir Med Case Rep. 2024; 47:101964. PMC: 10772803. DOI: 10.1016/j.rmcr.2023.101964. View

15.

Hamakawa M, Ishida T . Efficacy of dupilumab as an alternative to corticosteroids in the treatment of exacerbations of allergic bronchopulmonary aspergillosis. Respirol Case Rep. 2024; 12(4):e01354. PMC: 11009483. DOI: 10.1002/rcr2.1354. View

16.

Asano K, Ueki S, Tamari M, Imoto Y, Fujieda S, Taniguchi M . Adult-onset eosinophilic airway diseases. Allergy. 2020; 75(12):3087-3099. DOI: 10.1111/all.14620. View

17.

Wardlaw A, Rick E, Pur Ozyigit L, Scadding A, Gaillard E, Pashley C . New Perspectives in the Diagnosis and Management of Allergic Fungal Airway Disease. J Asthma Allergy. 2021; 14:557-573. PMC: 8164695. DOI: 10.2147/JAA.S251709. View

18.

Sumi T, Suzuki K, Koshino Y, Ikeda T, Yamada Y, Chiba H . Successful Treatment of Mucus Plug Due to Allergic Bronchopulmonary Aspergillosis Using Dupilumab. Cureus. 2024; 16(3):e55884. PMC: 11003194. DOI: 10.7759/cureus.55884. View

19.

Chen P, Yu Y, He L, Zhang C, Li Y, Wu D . Efficacy of omalizumab in adult patients with allergic bronchopulmonary aspergillosis: a multicentre study in China. Clin Exp Med. 2024; 24(1):6. PMC: 10799107. DOI: 10.1007/s10238-023-01267-y. View

20.

Tomomatsu K, Yasuba H, Ishiguro T, Imokawa S, Hara J, Soeda S . Real-world efficacy of anti-IL-5 treatment in patients with allergic bronchopulmonary aspergillosis. Sci Rep. 2023; 13(1):5468. PMC: 10073186. DOI: 10.1038/s41598-023-32246-8. View