Features of allergic bronchopulmonary aspergillosis (ABPA) are all except

Ans. d (Raised IgA levels). (Ref. Harrison's 18th/Ch. 204)ABPA represents a hypersensitivity reaction to A. fumigatus; rare cases are due to other aspergilli and other fungi. ABPA occurs in ~1% of patients with asthma and in up to 15% of adults with cystic fibrosis. Episodes of bronchial obstruction with mucous plugs leading to coughing fits, "pneumonia," consolidation, and breathlessness are typical. Eosinophilia commonly develops before systemic glucocorticoids are given. The cardinal diagnostic tests include an elevated serum level of total IgE (usually >1000 IU/mL), a positive skin-prick test to A. fumigatus extract, or detection of Aspergillus- specific IgE and IgG (precipitating) antibodies. Central bronchiectasis is characteristic. Primary Rx is Itraconazole therapy.ABPAPrimary diagnostic criteria for Allergic bronchopulmonary aspergillosis (ABPA)Secondary diagnostic criteria (less common)1)Asthma (84-96%) (Episodes of bronchospasm)1)Aspergillus fumigatus mycelias in sputum2)Roentgenographic transient or fixed pulmonary infiltrates2)Expectoration of brown sputum plugs (54%)3)Test for Aspergillus fumigatus positive (skin)3)Arthus reaction to Aspergillus antigen.4)Eosinophilia (8-40%)4)Fungal ball with Air crescent or Monads' sign is characteristic of aspergilloma.5)Precipitating antibodies to Aspergillus fumigatus (70%) 6)IgE in serum elevated 7)Central (Proximal/perihilar) bronchiectasis (late manifestation that proves diagnosis) 8)Serum specific IgE and IgG A. fumigatus levels elevated.