Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis

Agarwal, Ritesh; Gupta, Dheeraj; Aggarwal, Ashutosh N.; Saxena, Akshay Kumar; Saikia, Biman; Chakrabarti, Arunaloke; Jindal, Surinder K.

doi:10.1016/j.rmed.2009.09.005

Cited by 87 publications

(92 citation statements)

References 22 publications

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“…Importantly, improvement in spirometric parameters at 6 weeks and time to first exacerbation were similar in the two groups, which further suggests that the IgE decline is of little significance. The clinical significance of a decline in serum IgE is not known and in one study the quantum decline in IgE was not a predictor of exacerbation in ABPA [19]. Due to a higher total steroid dose (almost 2.5 times higher), the frequency of adverse events (cushingoid habitus and weight gain) were significantly higher in the high-dose steroid arm.…”

Section: Discussionmentioning

confidence: 94%

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A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma

et al. 2015

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Whether use of high-dose steroids in acute-stage allergic bronchopulmonary aspergillosis (ABPA) is associated with superior outcomes is not known. Herein, we compare the efficacy and safety of two glucocorticoid protocols in ABPA.Treatment-naive ABPA subjects randomly received either high-dose or medium-dose oral prednisolone. The primary outcomes were exacerbation rates and glucocorticoid-dependent ABPA after 1 and 2 years, respectively, of treatment. The secondary end-points were composite response rates after 6 weeks, improvement in lung function, time to first exacerbation, cumulative dose and adverse effects.92 subjects (high-dose n=44, medium-dose n=48) were included in the study. The numbers of subjects with exacerbation after 1 year (high-dose 40.9% versus medium-dose 50%, p=0.59) and glucocorticoiddependent ABPA after 2 years (high-dose 11.4% versus medium-dose 14.6%, p=0.88) were similar in the two groups. Although composite response rates were significantly higher in the high-dose group, improvement in lung function and time to first exacerbation were similar in the two groups. Cumulative glucocorticoid dose and side-effects were significantly higher in the high-dose group.Medium-dose oral glucocorticoids are as effective and safer than high-dose in treatment of ABPA.@ERSpublications Medium-dose glucocorticoids are as effective as high-dose in treatment of allergic bronchopulmonary aspergillosis

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Section: Discussionmentioning

confidence: 94%

“…Chest HRCT was used to classify ABPA as serologic ABPA, ABPA with bronchiectasis or ABPA with high-attenuation mucus [18]. The detailed methodology of each of the aforementioned investigations has been previously described [8, [19][20][21][22][23][24][25][26][27].…”

Section: Study Proceduresmentioning

confidence: 99%

A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma

et al. 2015

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“…Even after five decades of research this disorder is under diagnosed. In the developing countries, one-third of cases with ABPA are still misdiagnosed as pulmonary tuberculosis [5]. Though asthma is the most common contributing factor, ABPA is also seen in patients with cystic fibrosis and other underlying bronchiectatic diseases.…”

Section: Introductionmentioning

confidence: 99%

Allergic Bronchopulmonary Aspergillosis-The HRCT Chest Imaging Scenario

Kaur

Sudan

2014

JCDR

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Introduction: Allergic bronchopulmonary aspergillosis (ABPA) is a progressive disease which can lead to recurrent exacerbations, bronchiectatic changes and end-stage fibrosis. Early diagnosis and treatment prevents its progression and alleviate its clinical manifestations. High resolution CT of the chest has emerged as a promising investigation for its diagnosis. Aims and Objectives:To review the high resolution computed tomography (HRCT) chest manifestations in ABPA patients. Materials and Methods:This study included 110 patients with ABPA who had undergone HRCT of the chest in the routine diagnostic workup for ABPA. The scans were assessed for changes in bronchi, parenchyma and pleura and findings consistent with ABPA were evaluated.Results: HRCT chest was normal in 24 patients. 86 patients demonstrated central bronchiectasis with predilection for upper and middle lobes. Centrilobular nodules with or without linear opacities (tree in bud pattern), mucoceles and high-attenuation mucus were seen in 86%, 59% and 36% patients respectively. Conclusion:Central bonchiectasis combined with centrilobular nodules and mucus impaction (especially high attenuation mucus) strongly favour the diagnosis of ABPA.

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“…The rationale behind the use of steroids in ABPA exacerbations is their ability to relieve airway obstruction, decrease sputum production and hasten resolution of pulmonary infiltrates due to their anti-inflammatory effects (inhibition of phospholipase A2 activity and arachidonic acid metabolism, decrease in inflammatory cell chemotaxis, cell adhesion and tissue infiltration, and diminished production of inflammatory cytokines) [14]. We have previously shown that the presence of severe bronchiectasis and high-attenuation mucus is associated with recurrent relapses [15][16][17]. Both our patients had severe bronchiectasis while one patient had high-attenuation mucus.…”

Section: Pulse Methylprednisolone In Allergic Bronchopulmonary Aspergmentioning

confidence: 99%

Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations

Sehgal

Agarwal

2014

European Respiratory Review

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Clinical significance of decline in serum IgE levels in allergic bronchopulmonary aspergillosis

Abstract: A 35% decline in serum IgE levels at six weeks is not seen in all patients with ABPA, and the decline is slower in patients with baseline IgE levels <2500IU/mL. The quantum decline in serum IgE levels does not predict clinical outcomes.

Cited by 87 publications

References 22 publications

A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma

A randomised trial of glucocorticoids in acute-stage allergic bronchopulmonary aspergillosis complicating asthma

Allergic Bronchopulmonary Aspergillosis-The HRCT Chest Imaging Scenario

Pulse methylprednisolone in allergic bronchopulmonary aspergillosis exacerbations

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