title: Allergic bronchopulmonary aspergillosis.
abstract: There remains a lack of agreement on diagnostic criteria and approaches to treatment of patients with allergic bronchopulmonary aspergillosis (ABPA). The results of a survey of American Academy of Allergy, Asthma, & Immunology members regarding these 2 issues are presented and compared for concordance with published recommendations. The literature was reviewed for pertinent reports, and an electronic survey was conducted of American Academy of Allergy, Asthma, & Immunology members and fellows regarding diagnostic criteria, numbers of patients evaluated for ABPA, and treatment approaches. From 508 respondents to the survey sent to 5155 US physicians in the American Academy of Allergy, Asthma, & Immunology database of members and fellows, 245 health professionals (48%) had treated at least 1 patient with ABPA in the previous year. For the diagnosis of ABPA, there was a difference in the threshold concentration of total serum IgE because 44.9% used ≥417 kU/L, whereas 42.0% used ≥1000 kU/L. Analysis of these findings suggests that ABPA might be underdiagnosed. With regard to pharmacotherapy, oral steroids were recommended for 97.1% of patients and oral steroids plus inhaled corticosteroids plus antifungal agent were used with 41.2% of patients. The armamentarium for treatment of ABPA includes oral corticosteroids as the initial treatment with inhaled corticosteroids used for management of persistent asthma. Azoles remain adjunctive. Published experience with omalizumab has been limited.
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: p-greenberger@northwestern.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Greenberger
authors.affiliation: Division of Allergy-Immunology, Department of Medicine, University of Wisconsin, Madison, Wis.
authors.forename: Robert K
authors.initials: RK
authors.lastname: Bush
authors.affiliation: Allergy, Asthma and Immunology Center of Alaska, University of Washington, Anchorage, Alaska.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Demain
authors.affiliation: Otolaryngology-Head and Neck Surgery, University of Texas Medical School at Houston, Houston, Texas.
authors.forename: Amber
authors.initials: A
authors.lastname: Luong
authors.affiliation: Section of Allergy-Immunology, Division of Infectious Diseases, Department of Internal Medicine, St Louis University, St Louis, Mo.
authors.forename: Raymond G
authors.initials: RG
authors.lastname: Slavin
authors.affiliation: Division of Allergy-Immunology, Department of Pediatrics, St Louis University, St Louis, Mo.
authors.forename: Alan P
authors.initials: AP
authors.lastname: Knutsen
mesh_terms: D000280:Administration, Inhalation; D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000486:Allergy and Immunology / Q000592:standards; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology / Q000235:genetics / Q000276:immunology / Q000382:microbiology / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D020022:Genetic Predisposition to Disease; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000935:Antifungal Agents; D015415:Biomarkers; D007073:Immunoglobulin E
keywords: Allergic; Aspergillosis; Asthma; Azole; Bronchopulmonar; IgE; Mycosis