Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Ritesh Agarwal, Inderpaul Singh Sehgal, Valliappan Muthu, David W. Denning, Arunaloke Chakrabarti, Kathirvel Soundappan, Mandeep Garg, Shivaprakash M. Rudramurthy, Sahajal Dhooria, Darius Armstrong-James, Koichiro Asano, Jean Pierre Gangneux, Sanjay H. Chotirmall, Helmut J.F. Salzer, James D. Chalmers, Cendrine Godet, Marcus Joest, Iain Page, Parameswaran Nair, P. ArjunRaja Dhar, Kana Ram Jat, Geethu Joe, Uma Maheswari Krishnaswamy, Joseph L. Mathew, Venkata Nagarjuna Maturu, Anant Mohan, Alok Nath, Dharmesh Patel, Jayanthi Savio, Puneet Saxena, Rajeev Soman, Balamugesh Thangakunam, Caroline G. Baxter, Felix Bongomin, William J. Calhoun, Oliver A. Cornely, Jo A. Douglass, Chris Kosmidis, Jacques F. Meis, Richard Moss, Alessandro C. Pasqualotto, Danila Seidel, Rosanne Sprute, Kuruswamy Thurai Prasad, Ashutosh N. Aggarwal

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: The International Society for Human and Animal Mycology (ISHAM) working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) a decade ago. There is a need to update these recommendations due to advances in diagnostics and therapeutics. METHODS: An international expert group was convened to develop guidelines for managing ABPA (caused by Aspergillus spp.) and allergic bronchopulmonary mycosis (ABPM; caused by fungi other than Aspergillus spp.) in adults and children using a modified Delphi method (two online rounds and one in-person meeting). We defined consensus as ≥70% agreement or disagreement. The terms "recommend" and "suggest" are used when the consensus was ≥70% and <70%, respectively. RESULTS: We recommend screening for A. fumigatus sensitisation using fungus-specific IgE in all newly diagnosed asthmatic adults at tertiary care but only difficult-to-treat asthmatic children. We recommend diagnosing ABPA in those with predisposing conditions or compatible clinico-radiological presentation, with a mandatory demonstration of fungal sensitisation and serum total IgE ≥500 IU·mL-1 and two of the following: fungal-specific IgG, peripheral blood eosinophilia or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normal A. fumigatus-IgE. Additionally, diagnosing ABPM requires repeated growth of the causative fungus from sputum. We do not routinely recommend treating asymptomatic ABPA patients. We recommend oral prednisolone or itraconazole monotherapy for treating acute ABPA (newly diagnosed or exacerbation), with prednisolone and itraconazole combination only for treating recurrent ABPA exacerbations. We have devised an objective multidimensional criterion to assess treatment response. CONCLUSION: We have framed consensus guidelines for diagnosing, classifying and treating ABPA/M for patient care and research.

Original languageEnglish
Article number2400061
JournalThe European respiratory journal
Volume63
Issue number4
DOIs
Publication statusPublished - 4 Apr 2024

Keywords

  • Adult
  • Child
  • Animals
  • Humans
  • Aspergillosis, Allergic Bronchopulmonary/diagnosis
  • Invasive Pulmonary Aspergillosis/diagnosis
  • Itraconazole/therapeutic use
  • Mycology
  • Prednisolone
  • Immunoglobulin E

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