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Published on: March 22, 2012
Recombinant Aspergillus fumigatus-Specific IgE for Monitoring Treatment Response and Detecting Exacerbations in
Valliappan Muthu1, Renu Kaur1, Mani Singh1
1Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Background:
Serum total IgE is the preferred biomarker for monitoring disease activity in allergic bronchopulmonary aspergillosis (ABPA). The utility of IgE directed against recombinant Aspergillus fumigatus antigens (rAsp-IgE) for monitoring treatment response and detecting exacerbations in ABPA remains unknown.
Objective:
To evaluate longitudinal changes in rAsp-IgEs during treatment of ABPA, compare their performance with serum total IgE and crude A. fumigatus-specific IgE (cAsp-IgE), and assess the utility of rAsp-IgEs for detecting ABPA exacerbations.
Methods:
We prospectively enrolled consecutive adults with ABPA. Serum total IgE, cAsp-IgE, and rAsp-IgEs (f1, f2, and f4) were measured at baseline, 2, and 4 months of treatment. We assessed the proportion of participants achieving a ≥20% decline in each biomarker. Participants were followed for 12 months to identify exacerbations and evaluate biomarker behavior.
Results:
Among 122 enrolled participants, 119 and 107 completed the 2- and 4-month assessments. Serum total IgE and all 3 rAsp-IgEs declined significantly at both time points, whereas cAsp-IgE showed no significant decline. A ≥20% decline in at least one rAsp-IgE occurred more frequently than that in serum total IgE at 2 (91.6% vs 77.1%; P = .003) and 4 months (88.8% vs 74.8%; P = .007). Fifteen participants experienced exacerbations; rAsp f4-IgE increased in all events (100%) compared with total IgE (12 of 15, 80%), rAsp f1-IgE (7 of 15, 46.7%), and rAsp f2-IgE (6 of 15, 40%).
Conclusions:
rAsp-IgEs demonstrated significant longitudinal declines during ABPA treatment, whereas rAsp f4-IgE consistently increased during exacerbations. Larger multicenter prospective studies are warranted to define their role in disease monitoring.
