Allergic bronchopulmonary aspergillosis: A clinical review of 24 patients: Are we right in frequent serologic monitoring?

Abstract

BACKGROUND:Allergic Broncho Pulmonary Aspergillosis (ABPA) is a rare disease characterized by an allergic inflammatory response to the colonization by aspergillus or other fungi in the airways. The aim was to study the clinical, radiological, and serological characteristics of patients of ABPA.MATERIALS AND METHODS:A prospective observational study of patients with breathlessness, chronic cough, blood eosinophilia, and infiltrates on chest X-ray were evaluated with serologic and allergic skin fungal tests using 15 common fungal antigens. Total of 24 patients were diagnosed as ABPA.RESULTS:Total 24 patients, 15 males (62%), 9 females (38%). Age range: 14-70 years, mean 49.13, standard deviation (SD) 14.12. Central bronchiectasis — sixteen patients, bronchocoele — one patient, consolidation — five patients, collapse with mucous plugging with areas of consolidation — three patients, one patient had bronchiectasis, consolidation with hemorrhagic pleural effusion. Fifty-eight percent of patients had received anti-tuberculosis medications prior to diagnosis. Serum total IgE varied from 340 to 18100 IU/mL. Two patients had IgE levels below 1,000 IU/mL. The mean decrease in Serum total IgE levels at the end of 1 month was 26.1% (range: 0.7-71.9%) and at the end of 2 months was 58.9% (range: 11.11-93.26%) (P value of 0.004). Two patients had skin sensitivity to fungal antigens other than aspergillus species.CONCLUSION:ABPA is a disease with varied clinical, radiological, and serological patterns. Serum IgE monitoring may be done at the end of 2 and 6 months. Further studies are required to simplify the diagnosis and treatment algorithms in resource-limited countries.

Advances in the Diagnosis and Management of Pulmonary Aspergillosis

“…A common regimen starts with prednisone 0.5 mg/kg daily for 14 days followed by 0.5 mg/kg every other day with further tapering and discontinuation in 3 months [94]. There is a lack of clinical trials on the effectiveness of oral corticosteroids, but few case series have demonstrated responsiveness to prednisone with decline of total IgE, reduction in blood eosinophil counts, and clearance of radiographic lesions [91,98]. One unblinded randomized trial showed that medium dose of oral glucocorticoids is just as effective as high-dose oral glucocorticoids in the treatment of acute ABPA with fewer side effects [98,99].…”

“…There is a lack of clinical trials on the effectiveness of oral corticosteroids, but few case series have demonstrated responsiveness to prednisone with decline of total IgE, reduction in blood eosinophil counts, and clearance of radiographic lesions [91,98]. One unblinded randomized trial showed that medium dose of oral glucocorticoids is just as effective as high-dose oral glucocorticoids in the treatment of acute ABPA with fewer side effects [98,99]. Clinical response to treatment is monitored every 1-2 months with marked decrease in total serum IgE levels of > 35%, and resolution or improvement in radiographic infiltrates [75,100].…”

Allergic Bronchopulmonary Aspergillosis in Children with Cystic Fibrosis: An Update on the Newest Diagnostic Tools and Therapeutic Approaches

“…A reduction in serum IgE levels of 25% after one month of therapy and 60% after two months of therapy is expected. A serum IgE level decrease of at least 35% is considered a good therapeutic response [ 56 ].…”

Allergic Bronchopulmonary Aspergillosis: A Clinical Evaluation of 15 Patients and Successful Omalizumab Treatment of Five Patients

“…Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder associated with hypersensitivity reaction against inhaled Aspergillus fumigatus antigen (1). The prevalence of this disease is still unclear and this is probably due to the lack of a uniform diagnostic criteria (2).…”