Die allergische bronchopulmonale Aspergillose (ABPA)

G. Menz; G. Willer; R. Crameri

doi:10.1055/s-2000-7187

Pneumologie, Inhaltsverzeichnis

Pneumologie 2000; 54(9): 375-384
DOI: 10.1055/s-2000-7187

ORIGINALARBEIT

Georg Thieme Verlag Stuttgart · New York

Die allergische bronchopulmonale Aspergillose (ABPA)

G. Menz¹ , G. Willer¹ , R. Crameri²

¹Hochgebirgsklinik Davos Wolfgang/Schweiz, Abteilung Pneumologie II (Chefarzt: Dr. med. G. Menz)
²Schweizerisches Institut für Allergie- und Asthmaforschung (SIAF), Davos/Schweiz (Direktor: Prof. Dr. phil II K. Blaser)

Abstract

Zusammenfassung:

Die allergische bronchopulmonale Aspergillose (ABPA) ist die häufigste allergische bronchopulmonale Mykose bei Menschen. Die Diagnose des komplexen Kranheitsbildes basiert auf dem Nachweis definierter Kriterien. 5 klinische Stadien der ABPA werden unterschieden. Der Nachweis bzw. die Ausprägung der definierten Kriterien ist in den verschiedenen klinischen Stadien unterschiedlich. Dies kann die Diagnose der ABPA erschweren. Insbesondere ist die Unterscheidung der ABPA in der Remission (Stadium II) vom allergischen Asthma mit Aspergillus fumigatus Sensibilisierung schwierig und kann ein wichtiges Problem sein. Die frühe Diagnose der ABPA in einem Stadium noch ohne persistierende Veränderungen der Bronchialwand und Destruktionen des Lungenparenchyms ist sehr wichtig, um die schweren Endstadien der Erkrankung zu verhindern. Die bisher in der Diagnostik benutzten, kommerziellen Allergenextrakte sind nicht optimal standardisiert, zeigen „batch to batch”-Variationen, was zu einem Mangel an Reproduzierbarkeit der Untersuchungen führen kann. Die Möglichkeiten und Grenzen der bisher durchgeführten diagnostischen Verfahren zur Diagnose der ABPA werden beschrieben. Die Produktion einer Anzahl rekombinanter Allergene des Aspergillus fumigatus und ihre In-vivo- und In-vitro-Evaluation bringt die frühe und präzise Diagnose der ABPA einen wichtigen Schritt weiter. Die für die präzise Diagnostik wichtigen rekombinanten Allergene sind jetzt für die Routinebestimmung im CAP-System erhältlich.

Allergic Bronchopulmonary Aspergillosis (ABPA):

ABPA is the most common allergic bronchopulmonary mycosis in humans. The diagnosis of the complex disease is based on defined criteria. Five clinical stages of ABPA were proposed. The extend of the defined criteria varies in the different stages, thus making diagnosis difficult. Particularly the discrimination of ABPA in remission stage (stage II) and allergic asthma with A - sensitisation may be an important problem. Early diagnosis in stages without persistant changes of bronchial wall and lung parenchyma is needed to prevent severe end stages of ABPA. The up to now widely used commercial (crude) allergen extracts for in vitro and in vivo diagnosis show batch to batch variation, insufficient standardization and lack of reproducibility. Potentials and limitations of routine diagnostic procedures in ABPA are described. The production of a panel of recombinant allergens of A. fumigatus and their evaluation for in vivo and particularly in vitro use has brought an important step forward in the early and precise diagnosis of ABPA. A panel of recombinant allergens is now available for routine assay in CAP-System.

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Referenzen

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Dr. med G Menz

Hochgebirgsklinik Davos-Wolfgang Abt. Pneumologie II

7265 Davos Wolfgang Schweiz