From the Guidelines
Yes, there is a role for trending laboratory tests after completing treatment for Allergic Bronchopulmonary Aspergillosis (ABPA), as it allows for early detection of relapses and prompt reinitiation of treatment, potentially preventing permanent lung damage. After treatment completion, patients should have total serum IgE levels monitored every 3-6 months, as recommended by the revised ISHAM-ABPA working group clinical practice guidelines 1.
Key Monitoring Parameters
- Total serum IgE levels: every 3-6 months
- Lung function tests: every 3-6 months
- Clinical review: every 3-6 months
Rationale
The monitoring approach is crucial because ABPA has a relapsing and remitting course, and early detection of relapses allows for prompt reinitiation of treatment, potentially preventing permanent lung damage.
Additional Considerations
- Specific Aspergillus IgE and IgG antibodies should be monitored periodically, as should eosinophil counts.
- Chest imaging (X-ray or CT scan) is recommended at 6-month intervals initially, then annually if stable.
- Treatment adjustments, particularly corticosteroid tapering, should be guided by these laboratory and clinical parameters rather than fixed schedules, as supported by the guidelines 1.
Evidence Summary
The revised ISHAM-ABPA working group clinical practice guidelines provide the most recent and highest quality evidence for the management of ABPA, including the role of laboratory tests in monitoring disease activity and guiding treatment decisions 1.
From the Research
Role of Trending Laboratory Tests after Completing Treatment for ABPA
- The studies 2, 3, 4, 5, 6 suggest that trending laboratory tests, such as total IgE levels, eosinophil counts, and pulmonary function tests, can be useful in monitoring the response to treatment and detecting potential relapses in patients with Allergic Bronchopulmonary Aspergillosis (ABPA).
- According to 2, itraconazole therapeutic drug monitoring seems useful to prevent disease flares, and patients who experienced ABPA relapses displayed lower itraconazole trough levels during the first 3 months of treatment.
- The study 3 found that monoclonal antibodies, such as omalizumab, mepolizumab, benralizumab, and dupilumab, can be effective in reducing exacerbations, improving asthma symptoms, and improving pulmonary function parameters in patients with ABPA.
- The case report 4 highlights the potential role of dupilumab in the treatment of ABPA, with a significant improvement in lung function and a complete resolution of pulmonary symptoms.
- The study 5 found that high doses of inhaled corticosteroids alone have no role in the management of serological ABPA, but can be used as an add-on therapy for the control of symptoms of asthma.
- The case report 6 demonstrates the effectiveness of mepolizumab in treating ABPA, with dramatic improvements in symptoms, lung function, peripheral eosinophil counts, and chest images.
Laboratory Tests for Monitoring ABPA
- Total IgE levels: used to monitor the response to treatment and detect potential relapses 2, 5
- Eosinophil counts: used to monitor the response to treatment and detect potential relapses 3, 6
- Pulmonary function tests: used to monitor the response to treatment and detect potential relapses 2, 4, 6
- Itraconazole trough levels: used to monitor the effectiveness of itraconazole treatment and prevent disease flares 2