Criteria

2013 The International Society for Human and Animal Mycology (ISHAM) diagnostic criteria ABPA[1]

In 2013, the ISHAM working group proposed new criteria for the diagnosis and staging of ABPA should include:

Predisposing conditions:

  • Asthma or cystic fibrosis

Obligatory criteria (both should be present):

  • Type-I Aspergillus skin test positive (immediate cutaneous hypersensitivity to Aspergillus antigen) or elevated IgE levels against A fumigatus

  • Elevated total IgE levels (>1000 IU/mL)

Other criteria (at least two of three)

  • Presence of precipitating or IgG antibodies against A fumigatus in serum

  • Radiographic pulmonary opacities consistent with ABPA

  • Total eosinophil count >500 cells/microliter in steroid naive patients

2022 modified ISHAM criteria[29]

In 2022, the ISHAM working group updated their diagnostic criteria for ABPA to include:

The presence of both:

  • Serum Af-specific IgE >0.35 kUA/L

  • Serum total IgE >500 IU/mL

AND two of the following:

  • Serum Af-specific IgG >27 mgA/L

  • Bronchiectasis on CT chest

  • Peripheral blood total eosinophil count >500 cells/microliter

2003 Cystic Fibrosis Foundation consensus criteria[34] 

Classic case of ABPA in patients with CF defined as:

  • Acute or subacute clinical deterioration (increased cough, wheezing, exercise intolerance, increased sputum, decreased pulmonary function) that is not attributable to another etiology

  • Serum total IgE level of >1000 IU/mL unless patient is receiving systemic steroids

  • Presence of IgE antibodies to A fumigatus in vitro or immediate cutaneous reactivity to Aspergillus

  • Precipitating antibodies to A fumigatus or serum IgG antibody to A fumigatus by an in vitro test

  • New or recent infiltrates or mucus plugging on chest radiography or computed tomography that do not respond to antibiotics and standard physical therapy

Minimum diagnostic criteria for a diagnosis of ABPA should include:

  • Acute or subacute clinical deterioration that is not attributable to another etiology

  • Serum total IgE level of >500 IU/mL. If total serum IgE level is 200-500 IU/mL, repeat testing in 1-3 months

  • Immediate cutaneous reactivity to Aspergillus or presence of serum IgE-A fumigatus

AND one of the following:

  • Precipitating antibodies to A fumigatus or serum IgG antibody to A fumigatus in vitro

  • New or recent infiltrates or mucus plugging on chest radiography or computed tomography that do not respond to antibiotics and standard physical therapy

2010 revised radiographic classification of ABPA based on high attenuation mucus[43]

  • ABPA-S (serological ABPA)

    • Fulfills the diagnostic criteria of ABPA with no radiologic finding of ABPA on HRCT of the thorax

  • ABPA-B (bronchiectasis ABPA)

    • Fulfills the diagnostic requirements of ABPA plus presence of bronchiectasis.

  • ABPA-HAM (ABPA-high-attenuation mucus)

    • Fulfills the diagnostic requirements of ABPA, plus presence of high-attenuation mucus on HRCT chest

  • ABPA-CPF (ABPA-chronic pleuropulmonary fibrosis)

    • Fulfills the diagnostic criteria of ABPA with at least two radiologic features suggestive of fibrosis (including fibrocavitary lesions, pulmonary fibrosis, pleural thickening) without the presence of mucoid impaction (or HAM).

2021 diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis[35]​ 

​Diagnostic criteria for ABPA/ABPM based on the presence or absence of the following 10 components:

  • Current or previous history of asthma or asthmatic symptoms

  • Peripheral blood eosinophilia (≥500 cells/mm³)

  • Elevated total serum IgE levels (≥417 IU/mL)

  • Immediate cutaneous hypersensitivity or specific IgE for filamentous fungi

  • Presence of precipitins or specific IgG for filamentous fungi

  • Filamentous fungal growth in sputum cultures or bronchial lavage fluid

  • Presence of fungal hyphae in bronchial mucus plugs

  • Central bronchiectasis on CT

  • Presence of mucus plugs in central bronchi, based on CT/bronchoscopy or mucus plug expectoration history

  • High-attenuation mucus in the bronchi on CT

Interpretation of score:

  • 6/10 points is considered definite ABPM

  • 5/10 points is considered probable ABPM

1977 Rosenberg-Patterson clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis[33]

Major criteria

  • Asthma

  • Presence of fleeting or fixed pulmonary opacities on chest radiograph

  • Immediate cutaneous hypersensitivity reaction to Aspergillus fumigatus (A fumigatus)

  • Total serum IgE > 1000 IU/mL

  • Precipitating antibodies against AF

  • Peripheral blood eosinophilia

  • Central/proximal bronchiectasis with normal tapering of distal bronchi

Minor criteria

  • Golden brown mucus plugs in expectorant

  • Positive sputum culture for Aspergillus species

  • Late (arthus-type) skin sensitivity to A fumigatus

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