Which clinical syndrome is associated with an allergic-type reaction to Aspergillus in the lungs?

• A. Chronic pulmonary aspergillosis
• B. Invasive aspergillosis
• C. Aspergillus sinusitis
• D. Allergic bronchopulmonary aspergillosis (ABPA)

Answer: (D)

Allergic bronchopulmonary aspergillosis is an allergic-type reaction to Aspergillus antigens inhaled into the airways, not a true invasive infection. It typically affects people with asthma or cystic fibrosis, where the immune system—especially IgE–driven pathways—mounts a hypersensitivity response to the fungus living in the airways. This leads to eosinophilic inflammation, mucus plugging, and episodes of wheezing and coughing, often with transient or patchy infiltrates on imaging. A hallmark imaging feature is central bronchiectasis. Diagnostic clues include asthma or CF plus elevated total IgE, positive Aspergillus-specific IgE and/or IgG, eosinophilia, and a positive Aspergillus skin test. Treatment aims to control the allergic inflammation with corticosteroids and reduce fungal antigen burden with antifungals as appropriate. Other Aspergillus-related conditions—such as chronic pulmonary aspergillosis, invasive aspergillosis, or sinusitis—are driven by infection or invasion rather than a hypersensitivity reaction in the airways.