What are the absolute criteria for Allergic Bronchopulmonary Aspergillosis (ABPA)?

From the Guidelines

The absolute criteria for diagnosing Allergic Bronchopulmonary Aspergillosis (ABPA) include a predisposing condition or compatible clinico-radiological presentation, along with essential components such as A. fumigatus-specific IgE ≥0.35 kUA·L−1 and serum total IgE ≥500 IU·mL−1, as well as any two of the following: positive IgG against A. fumigatus, blood eosinophil count ≥500 cells·μL−1, or thin-section chest computed tomography consistent with ABPA 1.

Essential Components

• A. fumigatus-specific IgE ≥0.35 kUA·L−1
• Serum total IgE ≥500 IU·mL−1

Other Components

• Positive IgG against A. fumigatus
• Blood eosinophil count ≥500 cells·μL−1
• Thin-section chest computed tomography consistent with ABPA (bronchiectasis, mucus plugging, and high-attenuation mucus) or fleeting opacities on chest radiograph consistent with ABPA

Important Considerations

• High-attenuation mucus is pathognomonic of ABPA and confirms ABPA diagnosis even if all other criteria are not fulfilled 1
• Elevated IgE against rAsp f1, f2, and f4 supports the diagnosis of ABPA and could be used as another component for diagnosing ABPA 1
• A positive type 1 skin test is acceptable when Aspergillus-IgE is unavailable 1
• Serum total IgE <500 IU·mL−1 may be acceptable if all other criteria are fulfilled 1 The diagnosis of ABPA should be suspected in patients with predisposing conditions or a compatible clinico-radiological presentation, such as expectoration of mucus plugs, fleeting opacities on chest imaging, finger-in-glove opacities, and lung collapse 1.

From the Research

Absolute Criteria for ABPA

The absolute criteria for Allergic Bronchopulmonary Aspergillosis (ABPA) are not explicitly stated in the provided studies. However, the studies suggest that the diagnosis of ABPA can be made based on a combination of clinical, radiological, and immunological criteria.

Diagnostic Criteria

Some of the diagnostic criteria for ABPA mentioned in the studies include:

• Asthma or cystic fibrosis 2, 3, 4, 5, 6
• Positive skin test to Aspergillus 3, 6
• Recurrent infiltrates on radiographs 3, 6
• Elevations of total serum IgE concentration 3, 5, 6
• Peripheral blood and sputum eosinophilia 3, 6
• Presence of Aspergillus fumigatus in the airways 4

Threshold Concentration of Total Serum IgE

The studies mention different threshold concentrations of total serum IgE for the diagnosis of ABPA, including:

• ≥417 kU/L 5
• ≥1000 kU/L 5

Treatment Approaches

The treatment approaches for ABPA mentioned in the studies include:

• Oral steroids 3, 5, 6
• Inhaled corticosteroids 5
• Antifungal agents, such as itraconazole and voriconazole 3, 5, 6
• Omalizumab 5