Diagnosis of Allergic Bronchopulmonary Aspergillosis: A Case-Based Approach

Sahajal Dhooria; Ritesh Agarwal


Future Microbiol. 2014;9(10):1195-1208. 

In This Article

What Criteria Should Be Used for the Diagnosis & Classification of Aspergillus-related Hypersensitivity Phenomena in Asthma?

The Patterson criteria proposed more than three decades ago have been the basis for diagnosis of ABPA till date. These criteria however have certain limitations:[73] they place equal importance to all the components while some parameters such as IgE levels are more important than others; there is no consensus on the number of major or minor criteria necessary for the diagnosis. For example, if one makes the diagnosis of ABPA using at least five criteria then there is a fall in specificity while if we use at least seven criteria there is a fall in sensitivity;[8] the optimum cutoff values for IgE levels and eosinophil count are not specified; and the minor criteria seem to be redundant. The recent consensus-based guidelines have taken cognizance of the deficiencies of the previous criteria in the light of the knowledge accumulated over the years and have revised these criteria (Box 6).[7] The criteria are now simpler and more evidence based. Bronchiectasis has been removed from the diagnostic criteria as ABPA may present without bronchiectasis. The cutoff value of IgE has been proposed as 1000 IU/ml pending further validation, as it can help in differentiating severe asthma with fungal sensitization from ABPA-S. Minor criteria have been removed. The diagnostic algorithm shown in Figure 3 may be followed for arriving at the specific diagnosis. Patients who do not fulfill all the criteria for diagnosis may be categorized as 'ABPA-at risk', and should be kept under close followup (Box 7).

Figure 3.

Algorithm for the diagnosis of allergic bronchopulmonary aspergillosis in asthma.
ABPA: Allergic bronchopulmonary aspergillosis; ABPA-B: Allergic bronchopulmonary aspergillosis with bronchiectasis; ABPA-S: Serological allergic bronchopulmonary aspergillosis; Af: Aspergillus fumigatus; HRCT: High-resolution computed tomography; SAFS: Severe asthma with fungal sensitization; TIgE: Total IgE.