Hinson-Pepys Disease

Hinson-Pepys disease is another name for allergic bronchopulmonary aspergillosis (ABPA). It is an allergy-type disease of the lungs. The problem starts when a common fungus in the air—Aspergillus fumigatus—gets into the breathing tubes (bronchi). In most people the body clears the spores. But in some people, especially those who have asthma or cystic fibrosis (CF), the immune system overreacts. This strong allergic reaction causes swelling inside the airways, thick mucus plugs, and sometimes damage and widening of the air tubes (bronchiectasis). Over time, this can make breathing harder and can flare again and again unless treated. Wikipedia+1 Without control, the repeated inflammation can scar the lungs and lower lung function. In serious cases, it can lead to long-term bronchiectasis or other aspergillus-related lung problems. Merck Manuals

Hinson–Pepys disease is another name for allergic bronchopulmonary aspergillosis (ABPA). It happens when a person’s immune system overreacts to a common mold called Aspergillus fumigatus. This strong allergy causes swelling inside the breathing tubes (bronchi), thick sticky mucus, and sometimes widened airways called bronchiectasis. It usually occurs in people who already have asthma or cystic fibrosis. Doctors also call this condition an allergic lung disease rather than a typical infection. Wikipedia+2Orpha+2

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Other names

• Allergic bronchopulmonary aspergillosis (ABPA)

• Hinson-Pepys disease (historic eponym)

• Sometimes people say allergic aspergillosis or ABPA due to Aspergillus fumigatus. Wikipedia+1

(History note: ABPA was first clearly described in the 1950s by Hinson and colleagues; later work by Pepys helped define its allergic nature—hence the eponym.) PMC+1

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Types

Doctors group ABPA mainly by what scans and tests show. The names look technical, but here’s the simple idea:

1. Serologic ABPA (ABPA-S).
   You have the allergy blood tests and symptoms, but no clear airway damage on CT. Think of this as “early/milder form.” ScienceDirect

2. ABPA with central bronchiectasis (ABPA-CB).
   The medium–large central airways look widened/damaged on a high-resolution CT scan. This means the disease has started hurting the airway structure. NCBI

3. ABPA with high-attenuation (dense) mucus (often written ABPA-HAM or ABPA-CB-ORF).
   CT shows very dense “plugged” mucus that looks brighter than nearby muscle. This finding is strongly specific for ABPA and can confirm the diagnosis even if not all other criteria are met. It usually signals more active or severe disease. PMC+1

4. Allergic bronchopulmonary mycosis (ABPM).
   Same pattern as ABPA, but caused by other filamentous fungi, not only Aspergillus fumigatus. The work-up is similar. PMC

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Causes

ABPA has one core cause—a strong allergic reaction to Aspergillus in the airways. Many factors make this more likely or make it worse. Each short paragraph below names one real-world “cause/driver.”

1. Aspergillus exposure in the air.
   We all breathe tiny spores. High exposure (e.g., compost, decaying leaves, dusty barns) increases the chance of airway colonization and allergy.

2. Asthma.
   People with asthma are the main group who develop ABPA. The inflamed, mucus-prone airways make spores stick and trigger allergy. Merck Manuals

3. Cystic fibrosis (CF).
   Thick mucus in CF traps spores. About 1–15% of people with CF develop ABPA at some point. Wikipedia

4. Atopy (general allergy tendency).
   People who easily make IgE antibodies to allergens are more likely to make IgE to Aspergillus, too.

5. Impaired mucociliary clearance.
   Anything that slows the tiny hair-like cilia (e.g., chronic airway inflammation, thick mucus) lets spores stay and germinate.

6. Existing bronchiectasis.
   Damaged, widened airways collect mucus and are easily colonized by fungi, setting up the allergy cycle.

7. Genetic variants in CFTR (even in non-CF asthma).
   Some asthmatics carry CFTR changes that may raise ABPA risk. Wikipedia

8. Certain HLA immune patterns.
   Some HLA types are linked to stronger allergic immune responses to Aspergillus. Wikipedia

9. ZNF77 genetic variant.
   A premature stop in ZNF77 has been reported in some ABPA patients with asthma. Wikipedia

10. Warm, humid climate.
    Fungi flourish; spore loads are higher, increasing exposure.

11. Damp or moldy indoor spaces.
    Leaks, poor ventilation, or moldy buildings raise daily inhaled spore counts.

12. Chronic rhinosinusitis or nasal polyps.
    Upper-airway fungal growth can “seed” the lower airways and keep allergy active.

13. Frequent airway infections.
    Each infection leaves the bronchi more inflamed and mucus-prone, helping spores persist.

14. Poorly controlled asthma.
    Frequent wheeze and mucus plugging trap more spores and fuel the allergic cycle.

15. Air pollution and smoke.
    Irritants inflame the lining, slow cilia, and thicken mucus—conditions fungi like.

16. Use of hot tubs/indoor pools with poor maintenance.
    Moist, warm environments raise airborne fungal counts.

17. Occupational exposure (farmers, compost workers, grain handlers).
    High bioaerosol loads make ABPA more likely.

18. Immunologic imbalance (Th2-skewed response).
    Some people’s immune systems naturally tilt toward IgE/allergy.

19. Bronchial mucus properties.
    Very sticky or dehydrated mucus resists clearance and forms mucus plugs—a hallmark of ABPA on bronchoscopy or CT. PMC

20. Coexisting fungal sensitization beyond Aspergillus.
    Sensitivity to multiple filamentous fungi can amplify airway allergy and inflammation (sometimes classed as ABPM). PMC

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Common symptoms

1. Wheezing.
   A musical, whistling sound when breathing out, caused by swollen, narrowed airways—very common in ABPA with asthma. Wikipedia

2. Cough that keeps coming back.
   Often worse at night or early morning, due to airway irritation and mucus.

3. Thick sputum, sometimes brownish plugs.
   Mucus can build up into rubbery “casts” that may be coughed out. This can relieve breathlessness for a while.

4. Shortness of breath on activity.
   Swollen airways and mucus plugs limit airflow.

5. Chest tightness or pressure.
   A common asthma-type feeling during flares.

6. Low-grade fever and feeling unwell.
   Flares can mimic chest infections, but antibiotics alone do not help because the driver is allergy. Wikipedia

7. Fatigue and poor exercise tolerance.
   Ongoing airway inflammation makes daily tasks harder.

8. Recurrent “pneumonia-like” episodes.
   X-rays show patchy shadows that move around (fleeting infiltrates). Symptoms improve with steroids, not just antibiotics. Merck Manuals

9. Worsening asthma control.
   More inhaler use, more nighttime symptoms, and more flare-ups.

10. Coughing up blood (hemoptysis).
    Usually mild streaks; happens when fragile airway surfaces are inflamed.

11. Pleuritic chest pain.
    Sharp pain with deep breath or cough during active inflammation.

12. Sinus symptoms.
    Blocked nose, post-nasal drip, or facial pressure can travel with ABPA.

13. Weight loss or poor appetite (in severe, prolonged disease).
    Breathing effort and repeated flares can reduce intake.

14. Worsening breathlessness during humid or moldy weather or in damp buildings.
    These settings raise airborne spores.

15. Symptoms that improve quickly with oral steroids but return after stopping.
    A classic pattern because steroids calm the allergic swelling. Merck Manuals

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Diagnostic tests

Doctors combine symptoms, allergy tests, blood tests, and scans. There isn’t one single “yes/no” test, but there are well-accepted criteria (including specific IgE to Aspergillus and total IgE ≥ 417 IU/mL). A special CT sign—high-attenuation mucus—can confirm ABPA even if some other pieces are missing. Below are 20 tests grouped the way clinicians think about them. Merck Manuals+2MSD Manuals+2

A) Physical examination

1. Listening to the chest (auscultation).
   Doctors hear expiratory wheezes and sometimes coarse crackles if there is mucus in bigger airways.

2. Watching breathing effort.
   Fast breathing, use of neck muscles, or trouble speaking in full sentences suggests a flare.

3. Looking at sputum.
   Brownish, rubbery plugs are a bedside clue for ABPA and mucus impaction.

4. Nasal and sinus check.
   Polyps or chronic discharge support a broad allergic tendency that often accompanies ABPA.

B) Manual/office tests (4)

5. Skin prick test to Aspergillus fumigatus.
   A small wheal within 15–20 minutes shows immediate allergic sensitivity (IgE-mediated). It’s a quick, office-based test. Wikipedia

6. Intradermal skin test (if prick test is negative but suspicion remains).
   More sensitive than the prick test, still done at the bedside. education.aaaai.org

7. Peak expiratory flow (PEF).
   A handheld meter measures how fast you can blow out. Wide day-to-day swings suggest poorly controlled airway inflammation, common in ABPA.

8. Oxygen saturation (pulse oximetry).
   A finger probe checks oxygen level during a flare or exertion.

C) Laboratory and pathological tests

9. Total serum IgE.
   A high level supports ABPA. Many criteria use ≥ 417 IU/mL; some CF guidelines use ≥ 500 IU/mL (and ask to repeat if 200–500). Levels fall with treatment and rise if disease relapses. Merck Manuals+1

10. Aspergillus fumigatus–specific IgE.
    A positive result shows your immune system has made allergy antibodies to this fungus; it’s highly sensitive for ABPA. MSD Manuals

11. Aspergillus–specific IgG (or precipitins).
    These antibodies show ongoing exposure/colonization; they are more specific for ABPA than precipitins alone. MSD Manuals

12. Blood eosinophil count.
    Counts ≥ 500 cells/µL are common in ABPA (unless you recently used oral steroids, which lower eosinophils). eosinophilosophy.com

13. Component-resolved IgE (e.g., rAsp f1, rAsp f2).
    These more precise allergy tests can increase accuracy and are mentioned in the newest guidelines. PMC

14. Sputum or bronchoalveolar lavage (BAL) fungal culture.
    Finding A. fumigatus supports colonization. (A negative culture does not rule out ABPA.) eosinophilosophy.com

D) Physiologic / “electrodiagnostic” style tests

15. Spirometry (FEV₁, FEV₁/FVC).
    Shows airflow blockage typical of asthma/ABPA; used to track response to therapy over time.

16. Bronchodilator response testing.
    Spirometry before and after inhaled bronchodilator shows how reversible the narrowing is—important in ABPA with asthma.

17. Diffusing capacity or body plethysmography (lung volumes).
    These advanced lung function tests can show air-trapping or hyperinflation in chronic disease.

E) Imaging and visualization tests

18. Chest X-ray.
    Shows patchy, shifting (“fleeting”) shadows during flares. Helpful as a first look but less detailed than CT.

19. High-resolution CT (HRCT) of the chest.
    The key test to look for central bronchiectasis, mucus plugging, and especially high-attenuation (dense) mucus, which is pathognomonic (very specific) for ABPA. PMC

20. Sinus CT (when sinus disease is suspected).
    Helps if upper airway symptoms are present and supports the overall allergic picture.

Non-pharmacological treatments (therapies & others)

1. Allergen/mold exposure control at home.
   Purpose: Reduce breathing-tube irritation by lowering mold load.
   Mechanism: Less Aspergillus in the air means fewer allergens hitting airway immune cells. Actions: fix leaks, remove visible mold, ventilate kitchens/bathrooms.

2. Humidity control (target 40–50%).
   Purpose: Make indoor air less friendly to mold.
   Mechanism: Dehumidifiers and ventilation reduce spore growth on damp surfaces.

3. HEPA air filtration in sleeping area.
   Purpose: Cut airborne spores and dust.
   Mechanism: Mechanical trapping of particles including fungal spores.

4. Avoid high-exposure settings (compost, grain silos, dusty basements).
   Purpose: Prevent big allergen hits that can trigger flares.
   Mechanism: Source avoidance reduces immune triggers.

5. Wear a quality mask (e.g., N95) when exposure is unavoidable.
   Purpose: Personal barrier.
   Mechanism: Filters spores before they reach the airways.

6. Stop smoking and avoid secondhand smoke.
   Purpose: Reduce airway injury and mucus production.
   Mechanism: Smoking inflames and narrows bronchi; stopping lowers baseline irritation.

7. Structured airway-clearance therapy (ACT).
   Purpose: Help move out thick plugs.
   Mechanism: Techniques like huff-coughing, autogenic drainage, and oscillating PEP devices loosen and mobilize mucus.

8. Chest physiotherapy (percussion & postural drainage).
   Purpose: Clear mucus from deeper airways.
   Mechanism: Gravity plus vibrations help secretions travel upward.

9. Regular aerobic activity (as tolerated).
   Purpose: Improve stamina and mucus clearance.
   Mechanism: Deeper breaths and increased ciliary motion during activity.

10. Pulmonary rehabilitation program.
    Purpose: Teach breathing skills, pacing, and exercise safely.
    Mechanism: Supervised training improves ventilation efficiency and confidence.

11. Breathing exercises (diaphragmatic and pursed-lip breathing).
    Purpose: Ease shortness of breath.
    Mechanism: Slows exhalation, prevents airway collapse, improves gas exchange.

12. Written asthma/ABPA action plan & education.
    Purpose: Early response to flares.
    Mechanism: Clear steps for peak-flow drops, symptoms, and medicine changes.

13. Correct inhaler technique & adherence coaching.
    Purpose: Make medicines work better.
    Mechanism: Ensures the drug reaches the lungs, not the mouth.

14. Vaccinations (influenza yearly, pneumococcal as advised).
    Purpose: Prevent infections that worsen ABPA.
    Mechanism: Immune priming against common lung pathogens.

15. Sleep and reflux control (head-of-bed elevation; treat GERD).
    Purpose: Cut night symptoms and cough.
    Mechanism: Less acid micro-aspiration reduces airway irritation.

16. Sinus care if chronic rhinosinusitis.
    Purpose: Reduce post-nasal drip and triggers.
    Mechanism: Saline rinses and nasal steroids lower upstream inflammation.

17. Environmental cleaning routine (hot-wash bedding; remove old carpets/soft toys if moldy).
    Purpose: Reduce allergen reservoirs.
    Mechanism: Physical removal of spore-holding materials.

18. Stress management (mindfulness/yoga).
    Purpose: Lower stress-driven asthma flares.
    Mechanism: Decreases autonomic triggers and improves adherence.

19. Nutrition for bone and muscle health when on steroids.
    Purpose: Counter steroid side-effects.
    Mechanism: Adequate calcium/protein plus weight-bearing movement supports bone.

20. Medication interaction checks (especially with azole antifungals).
    Purpose: Avoid dangerous drug levels.
    Mechanism: Review CYP3A4 interactions (e.g., certain statins, benzodiazepines, and grapefruit).

(Items above complement, not replace, medical therapy recommended in current ABPA guidance.) ERS Publications+1

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Drug treatments (

1. Prednisolone (systemic corticosteroid).
   Dose/time: Often ~0.5 mg/kg/day, then taper per response.
   Purpose: First-line to calm acute inflammation.
   Mechanism: Broad anti-inflammatory effect on Th2 pathways and eosinophils.
   Side-effects: Weight gain, mood changes, glucose rise, osteoporosis. ERS Publications+1

2. Methylprednisolone (IV for severe flare).
   Dose/time: Commonly 40–60 mg IV daily short course.
   Purpose: Rapid control when oral route not possible.
   Mechanism/AE: Same class effects as above. ERS Publications

3. Itraconazole (oral triazole antifungal).
   Dose/time: 200 mg twice daily for ~16 weeks is evidence-based in trials.
   Purpose: Lowers airway Aspergillus burden and can reduce steroid need.
   Mechanism: Inhibits fungal ergosterol synthesis.
   Side-effects: Liver enzyme rise, drug interactions (CYP3A4). New England Journal of Medicine

4. Voriconazole (oral/IV triazole).
   Dose/time: Typical adult maintenance 200 mg twice daily (after loading/IV if needed); adjust with levels.
   Purpose: Alternative azole when itraconazole not tolerated.
   Mechanism: Ergosterol pathway inhibition.
   Side-effects: Visual changes, photosensitivity, hepatotoxicity, interactions. Mayo Clinic

5. Posaconazole (tablet/IV triazole).
   Dose/time: Loading 300 mg twice on day 1, then 300 mg daily.
   Purpose: Alternative/adjunct in difficult disease.
   Mechanism: Ergosterol pathway inhibition.
   Side-effects: Liver enzyme rise, drug interactions. Oxford Academic

6. High-dose inhaled corticosteroid (e.g., budesonide, fluticasone).
   Dose/time: Per asthma guidelines, twice daily.
   Purpose: Control baseline airway inflammation.
   Mechanism: Local anti-inflammatory in bronchi.
   Side-effects: Oral thrush, hoarseness (rinse mouth).

7. ICS/LABA combinations (e.g., budesonide-formoterol, fluticasone-salmeterol).
   Purpose: Better asthma control, fewer exacerbations.
   Mechanism: Anti-inflammatory + bronchodilation.
   Side-effects: As above plus tremor/palpitations (LABA).

8. Short-acting β₂-agonist (albuterol/salbutamol).
   Dose/time: As-needed reliever.
   Purpose: Quick symptom relief.
   Mechanism: Bronchial smooth-muscle relaxation.
   Side-effects: Tremor, tachycardia.

9. Long-acting muscarinic antagonist (tiotropium).
   Purpose: Add-on bronchodilation in asthma with airflow limitation.
   Mechanism: Blocks M3 receptors; reduces bronchoconstriction.
   Side-effects: Dry mouth.

10. Leukotriene receptor antagonist (montelukast).
    Purpose: Add-on control in allergic asthma.
    Mechanism: Blocks leukotriene-driven inflammation.
    Side-effects: Rare mood/sleep effects (discuss with clinician).

11. Omalizumab (anti-IgE biologic).
    Dose/time: Weight/IgE-based; often 150–375 mg SC every 2–4 weeks.
    Purpose: Steroid-sparing in IgE-mediated disease.
    Mechanism: Binds free IgE; down-regulates allergic cascade.
    Side-effects: Injection reactions; rare anaphylaxis. Evidence supports reduced exacerbations and steroid dose in ABPA. PMC

12. Mepolizumab (anti-IL-5 biologic).
    Dose/time: 100 mg SC every 4 weeks.
    Purpose: Control eosinophil-driven inflammation; steroid-sparing.
    Mechanism: Blocks IL-5 → lowers eosinophils.
    Side-effects: Headache, injection reactions. PMC

13. Benralizumab (anti-IL-5Rα biologic).
    Dose/time: 30 mg SC every 4 weeks ×3, then every 8 weeks.
    Purpose: Depletes eosinophils; improves control.
    Mechanism: Antibody-dependent eosinophil apoptosis via IL-5 receptor.
    Side-effects: Generally well tolerated. PMC+1

14. Dupilumab (anti-IL-4Rα biologic).
    Dose/time: 600 mg loading, then 300 mg SC every 2 weeks.
    Purpose: Blocks IL-4/IL-13 signaling; benefits type-2 inflammation and ABPA in reports.
    Side-effects: Injection reactions, conjunctivitis; rare eosinophilic pneumonia. PMC+2ClinicalTrials.gov+2

15. Tezepelumab (anti-TSLP biologic).
    Dose/time: 210 mg SC every 4 weeks (asthma label).
    Purpose: Upstream epithelial cytokine blockade; helpful in ABPA case reports.
    Side-effects: Sore throat, arthralgia. PMC+1

16. Reslizumab (anti-IL-5 biologic, IV).
    Dose/time: 3 mg/kg IV every 4 weeks (asthma label).
    Purpose/Mechanism: Lowers eosinophils; potential benefit in selected eosinophilic ABPA.
    Side-effects: Myalgias; rare anaphylaxis.

17. Nebulized hypertonic saline (3–7%).
    Purpose: Thins mucus to aid clearance.
    Mechanism: Osmotic water draw into airway lumen.
    Side-effects: Cough, bronchospasm (pretreat with bronchodilator).

18. N-acetylcysteine (nebulized or oral).
    Purpose: Mucolytic support.
    Mechanism: Breaks disulfide bonds in mucus; antioxidant effect.
    Side-effects: Bronchospasm (inhaled), GI upset (oral).

19. Antibiotics for bacterial bronchiectasis flares (as indicated).
    Purpose: Treat superimposed infection.
    Mechanism: Pathogen-directed therapy.
    Side-effects: Vary by agent; mind azole interactions (macrolides).

20. Calcium + vitamin D (supportive while on steroids).
    Purpose: Protect bone.
    Mechanism: Counter steroid-induced bone loss.
    Side-effects: Hypercalcemia if excessive.

Notes: International guidance specifically endorses prednisolone or itraconazole as first-line for acute ABPA; biologics are used as steroid-sparing options in difficult cases based on growing clinical evidence. Always review drug–drug interactions with azoles. ERS Publications+1

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Dietary molecular supplements

Evidence for supplements in ABPA itself is limited; the items below are adjuncts for airway health/asthma and should be used only after discussing interactions (especially with azole antifungals).

1. Vitamin D3 (1,000–2,000 IU/day; titrate to 25-OH-D ~30–50 ng/mL).
   Function: Immune modulation, bone protection during steroids.
   Mechanism: Regulates innate/adaptive immunity; supports calcium balance.

2. Omega-3 (EPA+DHA) (1–3 g/day).
   Function: Anti-inflammatory support.
   Mechanism: Resolvin/protectin pathways dampen airway inflammation.

3. Magnesium (200–400 mg/day).
   Function: Bronchial smooth-muscle relaxation; may reduce bronchospasm.
   Mechanism: Calcium antagonism at smooth-muscle level.

4. N-acetylcysteine oral (600 mg 1–2×/day).
   Function: Mucolytic/antioxidant.
   Mechanism: Restores glutathione; reduces mucus viscosity.

5. Probiotics (multi-strain Lactobacillus/Bifidobacterium).
   Function: Gut–lung axis support.
   Mechanism: Modulates immune tone via microbial metabolites.

6. Quercetin (250–500 mg twice daily).
   Function: Mast-cell stabilizing antioxidant.
   Mechanism: Inhibits histamine release/oxidative stress (limited clinical data).

7. Curcumin (500–1,000 mg/day with piperine).
   Function: Anti-inflammatory support.
   Mechanism: NF-κB pathway modulation (watch anticoagulants).

8. Vitamin C (500 mg 1–2×/day).
   Function: Antioxidant; supports immune function.
   Mechanism: Scavenges reactive oxygen species.

9. Zinc (10–20 mg/day, short courses).
   Function: Immune co-factor.
   Mechanism: Enzyme/cofactor roles in innate immunity (avoid excess).

10. Bromelain (250–500 mg/day).
    Function: Mucolytic/anti-edema support.
    Mechanism: Proteolytic activity may reduce secretion thickness.

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Immunity-modulating / regenerative” drugs

There are no approved stem-cell or “regenerative” drugs for ABPA. What we do use in hard-to-control cases are biologic immunomodulators that precisely block allergic pathways. Below are six such agents with practical dosing:

1. Omalizumab (anti-IgE): 150–375 mg SC every 2–4 weeks (weight/IgE-based). Helps reduce steroid need and exacerbations in ABPA. PMC

2. Mepolizumab (anti-IL-5): 100 mg SC every 4 weeks. Lowers eosinophils; helpful in ABPA reports. PMC

3. Benralizumab (anti-IL-5Rα): 30 mg SC every 4 weeks ×3, then every 8 weeks. Deep eosinophil depletion. fasenrahcp.com

4. Dupilumab (anti-IL-4Rα): 600 mg load, then 300 mg SC every 2 weeks. Blocks IL-4/IL-13; case reports/trials in ABPA. PMC+1

5. Tezepelumab (anti-TSLP): 210 mg SC every 4 weeks. Upstream epithelial cytokine block; ABPA case series show benefit. PMC+1

6. Reslizumab (anti-IL-5, IV): 3 mg/kg IV every 4 weeks in eosinophilic asthma; potential in selected ABPA. (Evidence base smaller than the agents above.)

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Procedures / surgeries

1. Flexible bronchoscopy with therapeutic suction/lavage.
   Why: Remove obstructing mucus plugs during a bad flare, improve airflow, get samples.

2. Bronchial artery embolization.
   Why: Control massive hemoptysis from bronchiectasis-related bleeding.

3. Segmentectomy/lobectomy (surgical resection).
   Why: Rare; for severely destroyed, localized lobe with recurrent infection/bleeding despite medical therapy.

4. Video-assisted thoracic surgery (VATS) support procedures.
   Why: Minimally invasive approach for selected resections/complications.

5. Endoscopic sinus surgery (if coexisting allergic fungal rhinosinusitis).
   Why: Reduce sinus fungal/allergen load that can worsen lower-airway disease.

(Surgery is uncommon in ABPA; medical therapy is the mainstay.) ERS Publications

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Prevention tips

1. Keep indoor humidity 40–50% and fix leaks quickly.

2. Ventilate bathrooms/kitchens; use exhaust fans and HEPA filtration in the bedroom.

3. Avoid compost piles, barns, and dusty basements; wear an N95 if exposure is unavoidable.

4. Do not smoke; avoid secondhand smoke.

5. Follow your action plan; check peak flow if advised.

6. Keep vaccines up to date (flu, pneumococcal as advised).

7. Learn and practice inhaler technique; use spacers when helpful.

8. Review drug interactions before starting azole antifungals (and avoid grapefruit).

9. Maintain regular airway-clearance routines.

10. Treat sinus disease and reflux to reduce lower-airway triggers. ERS Publications

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When to see a doctor

• Contact your doctor soon if you have: new or worsening wheeze/cough, brownish or blood-streaked sputum, fever, chest tightness, or need your reliever inhaler more often.

• Seek urgent care immediately for: severe breathlessness, blue lips or fingertips, coughing up large amounts of blood, confusion, or oxygen levels falling.

• People on steroids should report swelling, high sugars, mood changes, or infection signs. Those on azoles should report jaundice, dark urine, or severe fatigue (possible liver issues). ERS Publications

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What to eat and what to avoid

• Eat: a balanced anti-inflammatory pattern—fruits/vegetables, whole grains, legumes, lean proteins, omega-3-rich fish, nuts/seeds; adequate calcium and vitamin D (especially if on steroids); plenty of water to keep mucus looser.

• Limit/avoid: alcohol (hepatotoxicity risk with azoles), grapefruit and Seville orange (can raise azole levels dangerously), heavily mold-contaminated foods (visibly spoiled foods), and very salty ultra-processed foods (steroid-related fluid retention). There’s no strong evidence that avoiding all fungi-containing foods (e.g., mushrooms) changes ABPA outcomes. Oxford Academic

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Frequently Asked Questions

1. Is Hinson–Pepys disease the same as ABPA?
   Yes. It is an eponym for ABPA, the allergic lung reaction to Aspergillus. Wikipedia

2. Can I catch it from someone else?
   No. It’s an allergic reaction, not a contagious infection.

3. Who is at risk?
   Mostly people with asthma or cystic fibrosis. Wikipedia

4. How is it diagnosed?
   History plus blood tests (high total IgE, Aspergillus-specific IgE/IgG), sometimes eosinophilia, and CT chest looking for central bronchiectasis or high-attenuation mucus. PMC

5. What is “high-attenuation mucus”?
   Very dense mucus seen on CT; it is highly specific for ABPA and can confirm the diagnosis. Chest Journal+1

6. Why are steroids used?
   They quickly dampen the overactive allergic inflammation during flares. PMC

7. Why give antifungals like itraconazole?
   Lowering Aspergillus load can reduce immune triggering and spare steroids. Randomized trials support itraconazole use. New England Journal of Medicine

8. Do biologic shots help?
   Yes, for many people with difficult disease. Anti-IgE, anti-IL-5/5R, anti-IL-4Rα, and anti-TSLP have shown benefits in studies and case series. PMC+3PMC+3PMC+3

9. Will I need surgery?
   Usually no. Surgery is reserved for rare complications (e.g., localized destroyed lobe or major bleeding). ERS Publications

10. Can ABPA be cured?
    It tends to wax and wane. Many people achieve long remissions with proper care.

11. How do doctors monitor it?
    By symptoms, lung function, imaging when needed, and IgE trends (falling after treatment, rising if relapsing). Wikipedia

12. Is it the same as “allergic fungal asthma”?
    They overlap but are not identical. ABPA has specific immunologic and radiologic criteria and often bronchiectasis. PMC

13. Can children get ABPA?
    Yes, especially those with cystic fibrosis; pediatric care teams follow similar principles. Wikipedia

14. Is air travel safe?
    Usually yes when stable; carry inhalers/meds and avoid obvious mold exposures.

15. What about “stem-cell therapy”?
    Not recommended or approved for ABPA. Targeted biologic drugs are the evidence-based immunomodulators. ERS Publications

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: September 12, 2025.

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