Revised clinical practice guidelines for diagnosing, classifying, and treating allergic bronchopulmonary aspergillosis/mycoses: a Delphi statement from the ISHAM-ABPA working group
Ritesh Agarwal
(1)
,
Inderpaul Singh Sehgal
(1)
,
Valliappan Muthu
(1)
,
David W Denning
(2)
,
Arunaloke Chakrabarti
,
Kathirvel Soundappan
(1)
,
Mandeep Garg
(1)
,
Shivaprakash M Rudramurthy
(1)
,
Sahajal Dhooria
(1)
,
Darius Armstrong-James
(3)
,
Koichiro Asano
(4)
,
Jean-Pierre Gangneux
(5)
,
Sanjay Chotirmall
,
Helmut J. F. Salzer
(6)
,
James D. Chalmers
(7)
,
Cendrine Godet
(8)
,
Marcus Joest
(9)
,
Iain Page
,
Parameswaran Nair
(10)
,
P Arjun
(11)
,
R Dhar
,
Kana Ram Jat
(12)
,
Geethu Joe
,
Uma Maheswari Krishnaswamy
,
Joseph L Mathew
(1)
,
Venkata Nagarjuna Maturu
,
A Mohan
(12)
,
A Nath
,
Dharmesh Patel
,
Jayanthi Savio
,
Puneet Saxena
,
Rajeev Soman
,
Balamugesh Thangakunam
,
Caroline G Baxter
(13)
,
Felix Bongomin
(2)
,
William J Calhoun
(14)
,
Oliver Cornely
(15)
,
Jo A Douglass
(16)
,
Chris Kosmidis
(2)
,
Jacques F. Meis
(15)
,
Richard Moss
(17)
,
Alessandro C Pasqualotto
,
Danila Seidel
(18)
,
Rosanne Sprute
(15)
,
Kuruswamy Thurai Prasad
(1)
,
A Aggarwal
(1)
1
PGIMER -
Postgraduate Institute of Medical Education & Research
2 University of Manchester [Manchester]
3 Imperial College London
4 Tokai University
5 Irset - Institut de recherche en santé, environnement et travail
6 Kepler University Hospital
7 University of Dundee
8 CHU Tenon [AP-HP]
9 Center for Rhinology and Allergology = Zentrum für Rhinologie und Allergologie
10 McMaster University [Hamilton, Ontario]
11 KIMS - Karpaga Vinayaga Institute of Medical Sciences
12 All India Institute of Medical Sciences [New Delhi]
13 MFT - Manchester University NHS Foundation Trust
14 UTMB - The University of Texas Medical Branch
15 Universität zu Köln = University of Cologne
16 The Royal Melbourne Hospital
17 Stanford University
18 University Hospital of Cologne [Cologne]
2 University of Manchester [Manchester]
3 Imperial College London
4 Tokai University
5 Irset - Institut de recherche en santé, environnement et travail
6 Kepler University Hospital
7 University of Dundee
8 CHU Tenon [AP-HP]
9 Center for Rhinology and Allergology = Zentrum für Rhinologie und Allergologie
10 McMaster University [Hamilton, Ontario]
11 KIMS - Karpaga Vinayaga Institute of Medical Sciences
12 All India Institute of Medical Sciences [New Delhi]
13 MFT - Manchester University NHS Foundation Trust
14 UTMB - The University of Texas Medical Branch
15 Universität zu Köln = University of Cologne
16 The Royal Melbourne Hospital
17 Stanford University
18 University Hospital of Cologne [Cologne]
Ritesh Agarwal
- Fonction : Auteur correspondant
Inderpaul Singh Sehgal
- Fonction : Auteur
- PersonId : 1365443
- ORCID : 0000-0002-6505-6019
David W Denning
- Fonction : Auteur
- PersonId : 955815
- ORCID : 0000-0001-5626-2251
Arunaloke Chakrabarti
- Fonction : Auteur
- PersonId : 1104791
Sahajal Dhooria
- Fonction : Auteur
- PersonId : 1365444
- ORCID : 0000-0003-3199-9163
Jean-Pierre Gangneux
- Fonction : Auteur
- PersonId : 756001
- ORCID : 0000-0002-4974-5607
- IdRef : 074162063
Sanjay Chotirmall
- Fonction : Auteur
- PersonId : 1270320
- ORCID : 0000-0003-0417-7607
Iain Page
- Fonction : Auteur
Parameswaran Nair
- Fonction : Auteur
- PersonId : 1174431
- ORCID : 0000-0002-1041-9492
R Dhar
- Fonction : Auteur
Geethu Joe
- Fonction : Auteur
Uma Maheswari Krishnaswamy
- Fonction : Auteur
Venkata Nagarjuna Maturu
- Fonction : Auteur
A Nath
- Fonction : Auteur
Dharmesh Patel
- Fonction : Auteur
Jayanthi Savio
- Fonction : Auteur
Puneet Saxena
- Fonction : Auteur
Rajeev Soman
- Fonction : Auteur
Balamugesh Thangakunam
- Fonction : Auteur
Felix Bongomin
- Fonction : Auteur
- PersonId : 1333741
- ORCID : 0000-0003-4515-8517
Oliver Cornely
- Fonction : Auteur
- PersonId : 797225
- ORCID : 0000-0001-9599-3137
Alessandro C Pasqualotto
- Fonction : Auteur
- PersonId : 1132504
Rosanne Sprute
- Fonction : Auteur
- PersonId : 806772
- ORCID : 0000-0003-2457-6437
Résumé
BACKGROUND: The ISHAM working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) nearly a decade ago. There is a need to update these recommendations due to advances in diagnostics and therapeutics. METHODS: An international expert group was convened to develop guidelines for managing ABPA (caused by Aspergillus spp.) and allergic bronchopulmonary mycosis (ABPM, fungi other than Aspergillus spp.) in adults and children using a modified Delphi method (two online rounds and one in-person meeting). We defined consensus as ≥70% agreement or disagreement. The terms "recommend" and "suggest" are used when the consensus was ≥70% and <70%. RESULTS: We recommend screening for A. fumigatus sensitization using fungus-specific IgE in all newly diagnosed adult asthmatics at tertiary care but only difficult-to-treat asthmatic children. We recommend diagnosing ABPA in those with predisposing conditions or compatible clinico-radiological presentation, with a mandatory demonstration of fungal sensitization and serum total IgE ≥500 IU·mL(-1) and two of the following: fungal-specific IgG, peripheral blood eosinophilia, or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normal A. fumigatus-IgE. Additionally, diagnosing ABPM requires repeated growth of the causative fungus from sputum.We do not routinely recommend treating asymptomatic ABPA patients. We recommend oral prednisolone or itraconazole monotherapy for treating acute ABPA (newly diagnosed or exacerbation), with prednisolone and itraconazole combination only for treating recurrent ABPA exacerbations. We have devised an objective multidimensional criterion to assess treatment response. CONCLUSION: We have framed consensus guidelines for diagnosing, classifying, and treating ABPA(M) for patient care and research.