When to suspect and work up allergic bronchopulmonary aspergillosis

Greenberger, Paul A.

doi:10.1016/j.anai.2013.04.014

Cited by 36 publications

(29 citation statements)

References 28 publications

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“…The diagnostic criteria most widely accepted are those proposed by Rosenberg and Patterson [6], modified by Greenberger [4,7]. Despite these criteria, it is sometimes difficult to differentiate patients with ABPA from Af-sensitized asthmatic patients without ABPA [2,8].…”

Section: Introductionmentioning

confidence: 99%

Molecular‐based allergy diagnosis of allergic bronchopulmonary aspergillosis in Aspergillus fumigatus‐sensitized Japanese patients

Tanimoto

Fukutomi

Yasueda

et al. 2015

Clin Experimental Allergy

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SummaryBackgroundDistinguishing between patients with allergic bronchopulmonary aspergillosis (ABPA) and Aspergillus fumigatus (Af)‐sensitized asthmatic patients without ABPA is sometimes difficult owing to the IgE‐cross‐reactivity between Af and other fungal allergens.ObjectiveTo establish the usefulness of molecular‐based allergy diagnostics using allergen components from Af in distinguishing ABPA from Af‐sensitized asthma without ABPA.MethodsSera from Japanese patients with ABPA (n = 53) and Af‐sensitized asthma without ABPA (n = 253) were studied. The levels of IgE and IgG antibodies to allergen components from Af and IgE antibodies to different fugal allergen extracts were measured by ImmunoCAP. Comorbid atopic dermatitis (AD) was taken into consideration in the sensitization profile analysis.ResultsPatients with ABPA possessed significantly higher levels of IgE antibodies to Asp f 1, and Asp f 2 than asthmatic patients without ABPA. The areas under the receiver operating characteristic curves for the levels of IgE to Asp f 1 and Asp f 2 as diagnostic markers of ABPA were 0.75 and 0.78, respectively. The presence of IgE positivity to Asp f 1 and/or Asp f 2 resulted in increased sensitivity while losing little specificity. Comorbid AD was associated with higher levels of IgE to Asp f 6 (manganese superoxide dismutase from Af, a ubiquitous pan‐allergen in fungi) and low but positive levels of IgE to other Af‐components, which hampered the serological discrimination of ABPA.Conclusions and Clinical RelevanceThe levels of IgE to Asp f 1 and/or Asp f 2 can effectively differentiate ABPA from Af‐sensitized asthma, suggesting that the amounts of IgE specific for these molecules are markers for genuine Af‐sensitization in ABPA. However, comorbid AD must be taken into consideration in the interpretation of high IgE to Asp f 6. Establishing of IgE‐sensitization profiles using panel of Af‐allergen components provides valuable information for distinguishing genuine vs. cross‐reactive sensitization in Af‐sensitized patients.

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Section: Introductionmentioning

confidence: 99%

Molecular‐based allergy diagnosis of allergic bronchopulmonary aspergillosis in Aspergillus fumigatus‐sensitized Japanese patients

Tanimoto

Fukutomi

Yasueda

et al. 2015

Clin Experimental Allergy

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“…Central bronchiectasis, which is considered a specific finding, may be obvious, subtle, or absent. Other findings may include hyperinflation, varying infiltrates or areas of consolidation, nodules, and manifestations of bronchiectasis, including linear opacities, ring opacities, and gloved-finger opacities representing mucoid impaction [3,5]. In this patient, CT chest demonstrated dominant 3 cm mass.…”

Section: Discussionmentioning

confidence: 90%

“…Typically, patients with ABPA have history of bronchial asthma or cystic fibrosis [3]. The susceptibility of some individuals, particularly cystic fibrosis and asthmatic patients to develop ABPA is not fully understood.…”

Section: Discussionmentioning

confidence: 99%

“…ABPA is an allergic pulmonary disorder usually caused by hypersensitivity to Aspergillus fumigatus (A fumigatus) that manifests with combination of clinical, laboratory, and radiographic findings including chronic asthma, recurrent pulmonary infiltrates, bronchiectasis, serum eosinophilia, an elevated total IgE level, and sensitization to A fumigatus by skin testing [1][2][3]. Occasionally, patients can develop a syndrome similar to ABPA caused by fungi other than A fumigatus and is called allergic bronchopulmonary mycosis [4].…”

Section: Introductionmentioning

confidence: 99%

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Allergic Bronchopulmonary Aspergillosis: A Diagnostic Challenge

Pokhare

Ylagan²,

Cheney³

2014

J Cytol Histol

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Allergic bronchopulmonary aspergillosis (ABPA) is an immunologic condition that results from an allergic immune response to Aspergillus fumigatus, most often occurring in a patient with bronchial asthma or cystic fibrosis. ABPA is diagnosed by constellation of clinical, laboratory, and radiographic criteria. In the absence of typical presentation, ABPA can be misdiagnosed. Our patient presented with a 3 cm right lower lobe lung mass and sub-centimeter right upper lobe lung nodules. The clinical features led to a presumptive diagnosis of lung carcinoma. The patient underwent preoperative bronchial washing and endobronchial biopsy. The washing sample showed large amount of thick mucus containing abundant eosinophils, Charcoat-Leyden crystals, and degenerated cellular debris consistent with "allergic mucin". These findings were initially overlooked and considered non-specific. Repeat sampling (needle biopsy) showed marked reactive pneumocyte hyperplasia in the background of inflammation, which was misdiagnosed as adenocarcinoma with lepidic growth pattern. The correct diagnosis was made only after the surgical resection of the lesion. Diagnosis of ABPA can be missed due to general unfamiliarity with this entity and its clinical presentation similar to the lung tumor. Accurate diagnosis can be derived from the bronchial washing if the features of "allergic mucin" are recognized and confirmed with microbiological examination.

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“…It appears that SAFS may be a completely different entity as ABPA can also occur in mild or moderate asthmatics. In a recent perspective, GREENBERGER [18] dwelled on the distinction between SAFS and ABPA. It is still not known how many patients with SAFS will eventually progress to ABPA/allergic bronchopulmonary mycoses (ABPM).…”

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confidence: 99%