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Proposed immunopathogenesis of ABPA. In the pathogenesis of ABPA, A. fumigatus proteases have a direct effect on bronchial epithelia causing epithelial cell damage with subsequent stimulation of cytokines and chemokines. Aspergillus proteins are processed via HLA-DR2/DR5 bearing dendritic cells that skew the Th0 response to a Th2 response. Th2 cytokines stimulate IgE synthesis and eosinophil activation. This leads to an eosinophilic inflammatory in the bronchial airways.
