Allergic bronchopulmonary aspergillosis: A systematic review of its management with a call to action in Saudi Arabia

Allergic bronchopulmonary aspergillosis (ABPA) is a relatively common, but underdiagnosed allergic complication of asthma and cystic fibrosis, occurring in about 13% and 9% of cases, respectively. Significant progress has been made over the last decade in establishing diagnostic criteria and a pragmatic clinical approach to its management with steroids, antifungals, and newer agents, including anti-immunoglobulin E (IgE) monoclonal antibodies. In spite of this, there is very little literature on ABPA in Saudi Arabia, and the few papers that do exist suggest that ABPA may be associated with Aspergillus species other than Aspergillus fumigatus. This is of particular concern since the recommended current diagnostic screening is based on A. fumigatus-specific IgE levels, and other Aspergillus species may have different clinical profiles. This article provides an overview of ABPA for the practicing physician, provides an up-to-date review of randomized controlled trials in ABPA, and highlights urgent research priorities for ABPA in Saudi Arabia.