TY - JOUR
T1 - Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses
AU - Agarwal, Ritesh
AU - Sehgal, Inderpaul Singh
AU - Muthu, Valliappan
AU - Denning, David W.
AU - Chakrabarti, Arunaloke
AU - Soundappan, Kathirvel
AU - Garg, Mandeep
AU - Rudramurthy, Shivaprakash M.
AU - Dhooria, Sahajal
AU - Armstrong-James, Darius
AU - Asano, Koichiro
AU - Gangneux, Jean-Pierre
AU - Chotirmall, Sanjay H.
AU - Salzer, Helmut J. F.
AU - Chalmers, James D.
AU - Godet, Cendrine
AU - Joest, Marcus
AU - Page, Iain
AU - Nair, Parameswaran
AU - Arjun, P.
AU - Dhar, Raja
AU - Jat, Kana Ram
AU - Joe, Geethu
AU - Krishnaswamy, Uma Maheswari
AU - Mathew, Joseph L.
AU - Maturu, Venkata Nagarjuna
AU - Mohan, Anant
AU - Nath, Alok
AU - Patel, Dharmesh
AU - Savio, Jayanthi
AU - Saxena, Puneet
AU - Soman, Rajeev
AU - Thangakunam, Balamugesh
AU - Baxter, Caroline G.
AU - Bongomin, Felix
AU - Calhoun, William J
AU - Cornely, Oliver A.
AU - Douglass, Jo A.
AU - Kosmidis, Chris
AU - Meis, Jacques F.
AU - Moss, Richard
AU - Pasqualotto, Alessandro C.
AU - Seidel, Danila
AU - Sprute, Rosanne
AU - Prasad, Kuruswamy Thurai
AU - Aggarwal, Ashutosh N.
N1 - Copyright ©The authors 2024.
PY - 2024/4
Y1 - 2024/4
N2 - 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.
AB - 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.
KW - Adult
KW - Child
KW - Animals
KW - Humans
KW - Aspergillosis, Allergic Bronchopulmonary/diagnosis
KW - Invasive Pulmonary Aspergillosis/diagnosis
KW - Itraconazole/therapeutic use
KW - Mycology
KW - Prednisolone
KW - Immunoglobulin E
UR - http://www.scopus.com/inward/record.url?scp=85189107438&partnerID=8YFLogxK
U2 - 10.1183/13993003.00061-2024
DO - 10.1183/13993003.00061-2024
M3 - Article
C2 - 38423624
SN - 0903-1936
VL - 63
JO - The European respiratory journal
JF - The European respiratory journal
IS - 4
M1 - 2400061
ER -