Serum IgE as an important aid in management of allergic bronchopulmonary aspergillosis

Ricketti, Anthony J.; Greenberger, Paul A.; Patterson, Roy

doi:10.1016/0091-6749(84)90089-7

Cited by 105 publications

(44 citation statements)

References 12 publications

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“…The serum IgE levels decline after therapy with steroids (22,36), and are also the most useful test for following up patients with ABPA. A doubling of the patient's baseline IgE levels indicates relapse of ABPA (37,38).…”

Section: Discussionmentioning

confidence: 99%

Role of Inhaled Corticosteroids in the Management of Serological Allergic Bronchopulmonary Aspergillosis (ABPA)

et al. 2011

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Background and Aim The treatment of choice for allergic bronchopulmonary aspergillosis (ABPA) is oral corticosteroids (OCS). However, they are associated with numerous adverse effects. Inhaled corticosteroids (ICS) are associated with fewer side-effects; however, their role in the management of ABPA remains controversial. In this retrospective study, we evaluate the role of high doses of ICS in serological ABPA (ABPA-S). Methods Patients with ABPA-S were treated with a combination of formoterol/budesonide (24-1600 micrograms per day), and followed up with history, physical examination, chest radiograph and total IgE levels at 6, 12, 18 and 24 weeks. Asthma control was evaluated using the Global Initiative for Asthma (GINA) criteria. OCS were initiated if the IgE levels continued to rise after six months of therapy with ICS. Results There were 8 men and 13 women with a mean (SD) age of 39.3 (12.9) years. There was subjective improvement in all patients treated with ICS but none had complete control of asthma. After six months of therapy with ICS, the median IgE levels increased by 99.3%. After the initiation of OCS, there was complete resolution of asthma symptoms in 19 patients, and IgE levels fell by a median of 52.6% at six weeks. The median duration of follow-up was 15 months after OCS therapy. Eighteen patients achieved complete remission and three patients had a relapse in the first three months after stopping OCS. One patient required longterm OCS and was classified as glucocorticoid-dependent ABPA. Conclusion High doses of ICS alone have no role in the management of ABPA-S and should not be used as first-line therapy. In patients receiving OCS or alternate therapy, ICS can be used as an add-on therapy for the control of symptoms of asthma.

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Section: Discussionmentioning

confidence: 99%

Role of Inhaled Corticosteroids in the Management of Serological Allergic Bronchopulmonary Aspergillosis (ABPA)

et al. 2011

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“…The values may reach to 30,000 IU/ml but the cut off needed for diagnosis of ABPA is greater than 417 IU/ml [Ricketti et al 1984]. Much of the IgE is the result of polyclonal B-cell activation and not specific to Aspergillus [Knutsen, 2011].…”

Section: Total Serum Ige Levelsmentioning

confidence: 99%

“…A negative skin prick test should be followed by an intradermal test, which is more sensitive. The test is positive if a wheal and erythema is observed within 20 min [Ricketti et al 1984]. Up to 28% of patients with asthma have positive skin test to Aspergillus but as mentioned before this is the initial screening and patients need to fulfill the minimal criteria for diagnosis of ABPA [Agarwal, 2011].…”

Section: Aspergillus Skin Testmentioning

confidence: 99%

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Management of allergic bronchopulmonary aspergillosis: a review and update

Mahdavinia

Grammer

2012

Ther Adv Respir Dis

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Abstract:Since the first description of allergic bronchopulmonary aspergillosis (ABPA) in the 1950s there have been numerous studies that have shed light on the characteristics and immunopathogenesis of this disease. The increased knowledge and awareness have resulted in earlier diagnosis and treatment of patients with this condition. This article aims to provide a summary and updates on ABPA by reviewing the results of recent studies on this disease with a focus on articles published within the last 5 years. A systematic search of PubMed/Medline with keywords of ABPA or allergic bronchopulmonary aspergillosis was performed. All selected articles were reviewed with a focus on findings of articles published from December 2006 to December 2011. The relevant findings are summarized in this paper.

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“…The term allergic bronchopulmonary aspergillosis (ABPA) was first coined in the 1950s to describe a florid form of fungal allergy caused by A. fumigatus (11). A number of case series and reports generally involving relatively small numbers of patients describing the clinical and immunological features of ABPA, over time has become elevated into a set of diagnostic criteria with considerable importance attached to the total serum IgE concentration (12,13). The features that were regarded as helpful in distinguishing ABPA from sensitization were a diagnosis of asthma or cystic fibrosis, fleeting lung shadows (rarely encountered these days), IgE sensitization to A. fumigatus either by SPT or specific IgE, A. fumigatus specific preciptins (now generally measured as specific IgG), a total IgE of >417 IU/L (equivalent to 1000ng/ml), and a marked peripheral blood eosinophilia.…”

mentioning

confidence: 99%