Allergic bronchopulmonary aspergillosis as a cause of bronchial asthma in children

Background: Allergic bronchopulmonary aspergillosis (ABPA) occurs in patients with asthma and cystic fibrosis. When aspergillus fumigatus spores are inhaled they grow in bronchial mucous as hyphae. It occurs in non immunocompromised patients and belongs to the hypersensitivity disorders induced by Aspergillus. Objective: To diagnose cases of allergic bronchopulmonary aspergillosis among asthmatic children and define the association between the clinical and laboratory findings of aspergillus fumigatus (AF) and bronchial asthma. Methods: Eighty asthmatic children were recruited in this study and divided into 50 atopic and 30 non-atopic children. The following were done: skin prick test for aspergillus fumigatus and other allergens, measurement of serum total IgE, specific serum aspergillus fumigatus antibody titer IgG and IgE (AF specific IgG and IgE) and absolute eosinophilic count. Results: ABPA occurred only in atopic asthmatics, it was more prevalent with decreased forced expiratory volume at the first second (FEV1). Prolonged duration of asthma and steroid dependency were associated with ABPA. AF specific IgE and IgG were higher in the atopic group, they were higher in Aspergillus fumigatus skin prick test positive children than negative ones. Wheal diameter of skin prick test had a significant relation to the level of AF IgE titer. Skin prick test positive cases for aspergillus fumigatus was observed in 32% of atopic asthmatic children. Conclusion: ABPA occurs in 1/3 of atopic asthmatic children and is related to the duration and severity of asthma.