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Diagnosis of allergic bronchopulmonary aspergillosis in patients with persistent allergic asthma using three
Vida Mortezaee1, Seyed Alireza Mahdaviani2, Mihan Pourabdollah2
1Department of Medical Mycology, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Background:
Allergic bronchopulmonary aspergillosis (ABPA) has been reported in various degrees among patients with persistent allergic asthma (PAA). Currently, there is no gold standard approach for diagnosis of ABPA.
Objectives:
In the current study, we aimed the evaluation of three different mainly used algorithms as Rosenberg & Patterson (A), ISHAM Working Group (B) and Greenberger (C) for diagnosis of ABPA in 200 patients with underlying PAA.
Methods:
All patients were evaluated using Aspergillus skin prick test (SPTAf), Aspergillus-specific IgE (sIgEAf) and IgG (sIgGAf), total IgE (tIgE), pulmonary function tests, radiological findings and peripheral blood eosinophil count. The prevalence rate of ABPA in PAA patients was estimated by three diagnostic criteria. We used Latent Class Analysis for the evaluation of different diagnostic parameters in different applied ABPA diagnostic algorithms.
Results:
Aspergillus sensitisation was observed in 30 (15.0%) patients. According to algorithms A, B and C, nine (4.5%), six (3.0%) and 11 (5.5%) of patients were diagnosed with ABPA, respectively. The sensitivity and specificity of criteria B and C were (55.6% and 99.5%) and (100.0% and 98.9%) respectively. sIgEAf and sIgGAf showed the high significant sensitivity. The performance of algorithm A, in terms of sensitivity and specificity, was somewhat better than algorithm B.
Conclusion:
Our study demonstrated that the sensitivity of different diagnostic algorithms could change the prevalence rate of ABPA. We also found that all of three criteria resulted an adequate specificity for ABPA diagnosis. A consensus patterns combining elements of all three criteria may warrant a better diagnostic algorithm.
Insights
Diagnosing allergic bronchopulmonary aspergillosis (ABPA) in persistent allergic asthma (PAA) patients is challenging. This study evaluated three diagnostic algorithms, finding that while all offer adequate specificity, a combined approach may improve diagnosis.
Area of Science:
- Medical Research
- Pulmonology
- Allergy and Immunology
Background:
- Allergic bronchopulmonary aspergillosis (ABPA) is a complication in persistent allergic asthma (PAA) patients.
- Current diagnostic methods for ABPA lack a definitive gold standard.
Purpose of the Study:
- To evaluate three primary diagnostic algorithms (Rosenberg & Patterson, ISHAM Working Group, Greenberger) for ABPA in 200 PAA patients.
- To compare the sensitivity and specificity of these algorithms.
Main Methods:
- Patients underwent Aspergillus skin prick tests, specific IgE and IgG testing, total IgE measurement, pulmonary function tests, radiological imaging, and eosinophil counts.
- Latent Class Analysis was employed to assess diagnostic parameters across the algorithms.
Main Results:
- Aspergillus sensitization was found in 15% of patients.
- ABPA prevalence varied by algorithm: 4.5% (A), 3.0% (B), and 5.5% (C).
- Criteria B and C showed high sensitivity (55.6%, 100.0%) and specificity (99.5%, 98.9%), with specific IgE and IgG being highly sensitive.
Conclusions:
- Diagnostic algorithm choice impacts ABPA prevalence estimates in PAA.
- All three evaluated criteria demonstrated sufficient specificity for ABPA diagnosis.
- A consensus diagnostic algorithm combining elements from existing criteria may enhance diagnostic accuracy.
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