Allergic Bronchopulmonary Aspergillosis: Lessons Learnt from Genetics

Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction, most often encountered in patients with bronchial asthma or cystic fibrosis (CF), as a consequence of colonisation of the tracheobronchial tree by Aspergillus fumigatus. 1 It complicates the course of 2% to 32% of patients with bronchial asthma and 1% to 15% of patients with CF. 2, The disease presents with varied clinical and radiographic manifestations ranging from an asymptomatic patient with or without pulmonary infiltrates to severe uncontrolled asthma with or without central bronchiectasis. ] ] However, only a minority of patients with Aspergillus sensitivity go on to develop the complete clinical picture of ABPA. 18 Why does the immune response in ABPA differ from Aspergillus sensitive asthma patients? 0] It has been hypothesised that ABPA develops in patients with bronchial asthma and CF who are genetically predisposed. 23 5] o consistent association between the HLA alleles and ABPA was noted. Since then, numerous studies have evaluated genetic predisposition in ABPA and