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