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ABPA Treatment — SCE Infectious Diseases MCQ

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EasyFungal InfectionsABPA TreatmentSCE Infectious Diseases

A 45-year-old man with cystic fibrosis develops allergic bronchopulmonary aspergillosis (ABPA). He has raised total IgE (3,500 IU/mL), positive Aspergillus-specific IgE, peripheral eosinophilia, and proximal bronchiectasis on CT. What is the first-line treatment?

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Correct answer: C — Systemic corticosteroids (Prednisolone 0.5 mg/kg/day for 2 weeks then taper) plus Itraconazole as a steroid-sparing agent

ABPA is an allergic/eosinophilic response to Aspergillus antigens in the airways — not tissue invasion. First-line treatment is systemic corticosteroids to suppress the eosinophilic inflammation, plus oral Itraconazole (200 mg BD with TDM) as a steroid-sparing agent and to reduce fungal burden. Inhaled corticosteroids alone are insufficient. Total IgE should be monitored as a disease activity marker (>2-fold rise from baseline suggests flare). Biological therapies (Omalizumab, Benralizumab, Dupilumab) are emerging options for steroid-refractory ABPA.

Reference: NICE 2024 – ABPA; ISHAM 2021 – ABPA guidelines; CF Trust 2024