Allergic Bronchopulmonary Aspergillosis in Brazil

a Case Report and Integrative Review

  • Roberta Kahwage Santos, Srta. Hospital Jean Bitar, Belém, Brazil
  • Gabriel de Jesus da Fonseca Loureiro, Sr. Hospital Ophir Loyola, Belém, Brazil
  • Letícia Barbosa Barros, Srta. Hospital Ophir Loyola, Belém, Brazil


Background: Prevalence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic adults is estimated in 2,5%, what matches to more than 4.8 million of patients around the world; from those, more than 1.4 million are only in Latin America. Most patients with the disease are immunocompetent and present themselves with a poorly controlled asthma, secretive cough and recurrent pneumonia.  It’s curiously sensible to glucocorticoids, so early diagnosis and treatment may prevent bronchiectasis; otherwise, if it isn’t recognized soon, may lead to ending stage pulmonary fibrosis. First described by Hinson in 1952, even after almost seven decades, it’s still hardly recognized and treated.

Methods and Findings: A case report was performed through clinical follow up of a patient evaluated in a Brazilian hospital diagnosed with ABPA after four years of poorly controlled asthma after even being in ICU and mechanic ventilation support. The patient presented eosinophilia high serum IgE, central bronchiectasis and positive prick test for Aspergillus fumigatus. There was also performed a integrative research of all the studies published in Brazil since the first case report in 1989. There were researched the platforms PubMed, BVS (that covers MedLine and LILACS bases), Scielo, Cochrane, JAMA, NEJM and LANCET using the descriptors “allergic bronchopulmonary aspergillosis” and “Brazil”. There was found 17 articles about ABPA, 10 meeting the inclusion criteria. Of those, only 4 covered clinical and epidemiological features of ABPA in asthmatic patients.

Conclusions: There are very few studies on ABPA in Brazil in the last 30 years. More research in the country is needed to make this diagnostic possibility part of severe asthma differential and lead the patients to earlier diagnosis.


1. Oguma T, Taniguchi M, Shimoda T, Kamei K, Matsuse H, Hebiawa A, et al. Allergic bronchopulmonary aspergillosis in Japan: A nationwide survey, Allergology International. 2017; 1-6. Available from:
2. Tracy MC, Okorie CUA, Foley EA, Moss RB. Allergic Bronchopulmonary Aspergillosis. J Fungi (Basel). 2016; 2(2): 2-17.
3. Denning, DW, Pleuvry A, Cole, DC. Global burden of allergic bronchopulmonary aspergillosis with asthma and its complication chronic pulmonary aspergillosis in adults. Medical Mycology. 2013; 51: 361-70.
4. Kanj A, Abdallah N, Soubani AO. The spectrum of pulmonary aspergillosis, Respiratory Medicine (2018), doi: 10.1016/j.rmed.2018.06.029.
5. Agarwal R, Dhooria S, Sehgal IS, Aggarwal AN, Garg M, Saikia B, Behera D, Chakrabarti A. A randomized trial of itraconazole versus prednisolone in acute-stage ABPA complicating asthma, CHEST (2018), doi: 10.1016/j.chest.2018.01.005.
6. Hinson KFW, Moon AJ, Plummer NS. Broncho-Pulmonary Aspergillosis: A Review And A Report Of Eight New Cases. Thorax. 1952. (7) 317.
7. Agarwal R, Sehgal IS, Dhooria S, Aggarwal AN. Developments in the diagnosis and treatment of allergic bronchopulmonary aspergillosis. Expert Review of Respiratory Medicine (2016). DOI: 10.1080/17476348.2016.1249853
8. Terashima T, Shinozaki T, Iwami E, Nakajima T, Matsuzaki T. A case of allergic bronchopulmonary aspergillosis successfully treated with mepolizumab. BMC Pulmonary Medicine. 2018; 18(53): 1-5.
9. Ueki S, Hebisawa A, Kitani M, Asano K and Neves JS. Allergic Bronchopulmonary Aspergillosis–A Luminal Hypereosinophilic Disease With Extracellular Trap Cell Death. Front. Immunol. 2018; (9): 2346. Available from doi: 10.3389/fimmu.2018.02346
10. Patel AR, Patel AR, Singh S, Singh S, Khawaja I. Diagnosing Allergic Bronchopulmonary Aspergillosis: A Review. Cureus. 2019; 11(4): e4550. Available from DOI 10.7759/cureus.4550
11. Rosenberg M, Patterson R, Mintzer R, Cooper BJ, Roberts M, Harris KE. Clinical and Immunologic Criteria for the Diagnosis of Allergic Bronchopulmonary Aspergillosis. Ann Intern Med. 2010; 86(4): 405-14.
12. Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R, Moss R, Denning DW and For the ABPA complicating asthma ISHAM working group. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria Clinical & Experimental Allergy. 2013; (43): 850–73.
13. Greenberger, PA. When to suspect and work up allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol, 2013; 111: 1-4.
14. Sisodia J, Bajaj T. Allergic Bronchopulmonary Aspergillosis. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:
15. Cunha FS, Valle SOR, Filho JE, Junior SDD, França AT. Omalizumabe como terapia adicional no tratamento da aspergilose broncopulmonar alérgica em asmáticos. J Bras Pneumol. 2018; 44(5): 439-41.
16. Aydin O, Sözener ZC, Soyygit S, Kendirlinan R, Gençturk Z, Misirligil Z, et al. Omalizumab in the treatment of allergic bronchopulmonary aspergillosis: One center’s experience with 14 cases. Allergy Asthma Proc. 2015; 36(6): 436-500.
17. Geller M. Allergic bronchopulmonary aspergillosis does exist in Brazil. Ann Allergy. 1989; 63(4): 325-6.
18. Londero AT, Guadalupe JMC. Aspergiloses pulmonares. J. pneumol. 1990; 16(2): 78-90.
19. Costa E, Blanc ES, França AT. Aspergilose broncopulmonar alérgica(ABPA): estudo comparativo das alteraçöes radiográficas pulmonares. Rev. bras. alergia imunopatol. 1995; 18(3): 103-7.
20. Kalil ME, Fernandes ALG, Curzel ACS, Cortez MZ, Lima GCGA, Aspergilose broncopulmonar alérgica com imagem radiológica em “dedo de luva". J Bras Pneumol. 2006; 32(5): 472-5.
21. Almeida MB, Bussamara MHCF, Rodrigues JC. ABPA diagnosis in cystic fibrosis patients: the clinical utility of IgE specific to recombinant Aspergillus fumigatus allergens. J Pediatr. 2006; 82(3): 215-20.
22. Oliveira E, Bianchi GP, Fonseca LAM, França AT, Kalil J. Allergic bronchopulmonary aspergillosis diagnosis remains a challenge. Respiratory Medicine. 2007; 101, 2352–7.
23. Carneiro ACC, Lemos ACM, Arruda SM, Santana MAPS. Prevalência de aspergilose broncopulmonar alérgica em pacientes com fibrose cística na Bahia, Brasil. J Bras Pneumol. 2008; 34(11): 900-6.
24. Campos LEMC, Pereira LFF. Eosinofilia pulmonar. J Bras Pneumol. 2009; 35(6): 561-73.
25. Armstead J, Morris J, Denning DW. Multi-Country Estimate of Different Manifestations of Aspergillosis in Cystic Fibrosis. PLoS ONE. 2014; 9(6): e98502. doi:10.1371/journal.pone.0098502
26. Baxter CG, Dunn G, Jones AM, Webb K, Gore R, Richardson MD, Denning DW. Novel immunologic classification of aspergillosis in adult cystic fibrosis. J Allergy Clin Immunol. 2013; 132(3): 560-66. e10. doi: 10.1016/j.jaci.2013.04.007. Epub 2013 May 29. PMID: 23726262
27. Aguiar SS, Damasceno N, Forte WCN. Exames para Avaliar a Sensibilização ao Aspergillus Fumigatus Em Fibrose Cística. Rev Paul Pediatr. 2017; 35(3): 252-7.
28. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2020. [Internet] Available from:
29. Kalaiyarasan, Jain AK, Puri M, Tayal D, Singhal R, Sarin R. Prevalence of allergic bronchopulmonary aspergillosis in asthmatic patients: A prospective institutional study. Indian J Tuberc. [Internet] 2018, Available from:
30. Agarwal R, Sehgall IS, Dhooria S, Muthu V, Prasad KT, Bal A, Aggarwal AN, Chakrabarti A. Allergic bronchopulmonary aspergillosis. Indian J Med Res. 2020; 151: 529-49.
How to Cite
SANTOS, Roberta Kahwage; LOUREIRO, Gabriel de Jesus da Fonseca; BARROS, Letícia Barbosa. Allergic Bronchopulmonary Aspergillosis in Brazil. International Archives of Medicine, [S.l.], v. 14, feb. 2021. ISSN 1755-7682. Available at: <>. Date accessed: 01 june 2023. doi:
Pulmonary and Critical Care Medicine