Allergic bronchopulmonary aspergillosis in India

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a lung disorder caused by immune‐mediated reactions mounted against Aspergillus fumigatus. The disorder most commonly complicates the course of patients with asthma and cystic fibrosis. From its first description in 1952, significant advances have been made in understanding the pathogenesis and the diagnosis and treatment of ABPA. In the last two decades, most research on ABPA has been published from India. The prevalence and clinical presentation may differ in India from that reported elsewhere. Herein, we review the epidemiology, clinical and radiological characteristics, and distinctive features of ABPA in the Indian subcontinent. To support the review, we surveyed pulmonologists nationwide to understand the challenges in diagnosing and managing ABPA. The survey has yielded valuable insights into the practices associated with the diagnosis and management of ABPA in India.

Allergy in India

“…ABPA patients in India present at a younger age with a relatively higher serum total IgE and the authors link ABPA to genetic predisposition and environmental factors and highlight the need for further research 5 . The authors conducted a survey amongst clinicians involved in the management of asthma in different healthcare sectors and highlight the heterogeneity in the diagnosis and management with a need to standardise clinical practice 5 . There are important challenges with respect to access and affordability to test for aspergillus sensitisation and relevant biomarkers, particularly in the rural and public sector.…”

“…4 Existing data suggest a very high rate of sensitisation to dust mites Agarwal et al, estimate the community prevalence of ABPA as 46.2 per 100,000 population in India, probably highest in the world, with a greater burden in rural compared to the urban community. 5,6 They estimate that there are approximately 1.4-1.9 million cases of ABPA in India. 5 ABPA patients in India present at a younger age with a relatively higher serum total IgE and the authors link ABPA to genetic predisposition and environmental factors and highlight the need for further research.…”

“…5,6 They estimate that there are approximately 1.4-1.9 million cases of ABPA in India. 5 ABPA patients in India present at a younger age with a relatively higher serum total IgE and the authors link ABPA to genetic predisposition and environmental factors and highlight the need for further research. 5 The authors conducted a survey amongst clinicians involved in the management of asthma in different healthcare sectors and highlight the heterogeneity in the diagnosis and management with a need to standardise clinical practice.…”

“…5 The authors conducted a survey amongst clinicians involved in the management of asthma in different healthcare sectors and highlight the heterogeneity in the diagnosis and management with a need to standardise clinical practice. 5 There are important challenges with respect to access and affordability to test for aspergillus sensitisation and relevant biomarkers, particularly in the rural and public sector. A cost-effective avenue for ABPA screening in the community might be to look into the feasibility of rapid aspergillus IgE testing using capillary blood on a test strip.…”

“…Agarwal et al, estimate the community prevalence of ABPA as 46.2 per 100,000 population in India, probably highest in the world, with a greater burden in rural compared to the urban community 5,6 . They estimate that there are approximately 1.4–1.9 million cases of ABPA in India 5 .…”