HLA antigen frequencies in allergic bronchopulmonary aspergillosis

[Allergic bronchopulmonary aspergillosis in children]

Allergic bronchopulmonary aspergillosis (ABPA) associates the development of aspergillus in bronchus and a predominant immediate hypersensitivity for aspergillus antigens. It complicates an old and severe allergic asthma or cystic fibrosis. Its prevalence is not well known. In children, ABPA prevalence is rare, except in cystic fibrosis where 0.6% to 11% of patients can be affected by the disease. Acute exacerbation of the disease favours the development of bronchiectasis and fibrosis. The diagnosis is suggested by an unexplained aggravation of asthma or, in cystic fibrosis, by wheezing, an unsuccessful antibiotherapy, and a recent modification of the chest X-ray. The diagnosis is based upon the presence of seven major criteria or six major criteria and one minor. The follow-up of biological parameters is important for early diagnosis of exacerbations. Some parameters are very sensitive, ie, precipitins and total serum IgE. Systemic corticotherapy is the usual treatment of exacerbation. The association with inhaled corticotherapy could reduce the duration of systemic treatment. The use of Itraconazole is logical, mainly in cystic fibrosis.

Extrinsic allergic bronchiolo-alveolitis in children

Fifteen children, 6-14 years old, who were heavily exposed to pigeon droppings, presented with cough, chills and breathlessnes on mild exertion. Twelve gave immediate positive skin test reactions to pigeon droppings. Ten of the fifteen also gave a late (Arthus) reaction, and seven gave a positive delayed reaction which was maximal at 24--72 hr. Nine children had precipitins against avian droppings. In ten patients who were tested for lymphocyte transformation, five gave positive responses to both serum and pigeon droppings. Radiological findings of the chest showed parenchymatous infiltrations and diffuse interstitial reticulations, suggestive of extrinsic allergic alveolitis. In a control group of fifteen heavily-exposed children who had no symptoms, immediate and late skin reactions occurred respectively in five and two. One only had a positive precipitin test, and one of five tested had a positive lymphoblastic transformation. In a non-exposed comparable group of children, all tests were negative except for one immediate positive skin response. Children heavily exposed to the inhalation of avian antigens can develop extrinsic allergic bronchiolo-alveolitis.