From the Guidelines
The erythrocyte sedimentation rate (ESR) is typically elevated in allergic bronchopulmonary aspergillosis (ABPA), and its monitoring can be useful in assessing disease activity and response to treatment, as recommended by the revised ISHAM-ABPA working group clinical practice guidelines 1. In patients with ABPA, ESR values commonly range from moderately to significantly elevated (often >30-40 mm/hr), reflecting the underlying inflammatory process. This elevation occurs because ABPA triggers a hypersensitivity reaction to Aspergillus fungi colonizing the airways, leading to systemic inflammation. While ESR is a non-specific inflammatory marker, it can be useful in monitoring disease activity and response to treatment in ABPA patients. However, ESR should not be used alone for diagnosis, as it must be interpreted alongside other clinical findings, including:
- Total IgE levels
- Aspergillus-specific IgE and IgG antibodies
- Eosinophilia
- Radiographic changes During acute exacerbations of ABPA, ESR typically increases and may gradually decrease with effective treatment, primarily consisting of systemic corticosteroids and sometimes antifungal medications, as outlined in the guidelines 1. Regular monitoring of ESR can help clinicians assess treatment efficacy, though changes in clinical symptoms and other more specific markers like total IgE are generally more reliable indicators of disease control. The revised ISHAM-ABPA working group clinical practice guidelines provide a comprehensive framework for diagnosing, classifying, and treating ABPA, and emphasize the importance of considering ESR as part of a broader diagnostic and monitoring approach 1. Some key points from the guidelines include:
- The use of A. fumigatus-specific IgE and serum total IgE levels in diagnosing ABPA
- The importance of imaging studies, such as thin-section computed tomography (CT), in assessing bronchiectasis and other radiological features
- The role of blood eosinophil count and other markers in guiding therapy and monitoring disease activity
- The recommendation for oral prednisolone or itraconazole monotherapy as initial treatment for acute ABPA, with combination therapy reserved for recurrent exacerbations 1. Overall, the guidelines provide a valuable resource for clinicians managing patients with ABPA, and highlight the importance of a comprehensive and multidisciplinary approach to diagnosis, treatment, and monitoring.
From the Research
ESR in Allergic Bronchopulmonary Aspergillosis
- The studies provided do not specifically mention ESR (Erythrocyte Sedimentation Rate) in the context of allergic bronchopulmonary aspergillosis (ABPA) 2, 3, 4, 5, 6.
- However, the diagnosis of ABPA is based on a combination of clinical, immunological, and radiological criteria, including episodic bronchial obstruction, peripheral blood eosinophilia, immediate cutaneous reactivity to A. fumigatus, and elevated total serum IgE 2.
- The treatment of ABPA typically involves oral corticosteroids, antifungal agents, and optimized asthma therapy 3, 4, 5, 6.
- While ESR is not a specific diagnostic criterion for ABPA, it may be elevated in patients with ABPA due to the underlying inflammatory process.
- Further research is needed to determine the role of ESR in the diagnosis and management of ABPA.
Diagnostic Criteria for ABPA
- The diagnostic criteria for ABPA include:
- Episodic bronchial obstruction
- Peripheral blood eosinophilia
- Immediate cutaneous reactivity to A. fumigatus
- Precipitating serum antibodies to A. fumigatus
- Elevated total serum IgE
- History of pulmonary infiltrates
- Elevated serum IgE and serum IgG to A. fumigatus
- Proximal bronchiectasis 2
- These criteria are regularly revised, and new diagnostic and classification criteria have been proposed 5.