title: Serological diagnosis of allergic bronchopulmonary mycosis: Progress and challenges.
abstract: Prompt diagnosis of allergic bronchopulmonary mycosis (ABPM) is an important clinical issue in preventing irreversible lung damage. Therefore, a good serological marker for the diagnosis of ABPM is desired in clinical practice. The measurement of IgE antibody to crude Aspergillus fumigatus allergen is considered the first step in screening asthmatic patients for allergic bronchopulmonary aspergillosis (ABPA). However, presence of IgE to A. fumigatus does not always indicate genuine sensitization to A. fumigatus because of cross-reactivity between crude extracts from different fungal sources. The application of molecular-based allergy diagnosis can solve this problem. The specificity of testing can be greatly improved by measuring the IgE antibody to Asp f 1 and f 2, specific allergen components for genuine A. fumigatus allergy. The problem of cross-reactivity between crude fungal extracts is also true for the identification of genuine causal fungi in each ABPM patient. Some patients with ABPM induced by fungi other than Aspergillus may be consistent with ABPA diagnostic criteria because current criteria depend on IgE/IgG reactivity to crude extracts. Accurate identification of genuine causal fungi for ABPM is of clinical importance, considering that clinical presentation, anti-fungal treatment strategies and disease prognosis can be influenced by different causal fungi. The diagnosis of causal fungi can be robustly validated by the confirmation of genuine sensitization to fungi after measuring IgE to specific allergen components, as well as repeated microbiological isolation of the fungi from their airway.
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan. Electronic address: y-fukutomi@sagamihara-hosp.gr.jp.
authors.forename: Yuma
authors.initials: Y
authors.lastname: Fukutomi
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Tanimoto
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yasueda
authors.affiliation: Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Kanagawa, Japan.
authors.forename: Masami
authors.initials: M
authors.lastname: Taniguchi
mesh_terms: D000485:Allergens / Q000276:immunology; D000908:Antibodies, Fungal / Q000276:immunology; D000918:Antibody Specificity / Q000276:immunology; D000946:Antigens, Fungal / Q000276:immunology; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000175:diagnosis* / Q000209:etiology*; D001232:Aspergillus fumigatus / Q000235:genetics / Q000276:immunology*; D003429:Cross Reactions / Q000276:immunology; D006801:Humans; D007073:Immunoglobulin E / Q000276:immunology; D007074:Immunoglobulin G / Q000276:immunology; D025202:Molecular Diagnostic Techniques; D012698:Serologic Tests / Q000379:methods
chemical_list: D000485:Allergens; D000908:Antibodies, Fungal; D000946:Antigens, Fungal; D007074:Immunoglobulin G; D007073:Immunoglobulin E
keywords: Allergic bronchopulmonary mycosis; Allergy; Aspergillus fumigatus; Fungi; Molecular-based allergy diagnostics