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The updated consensus guidelines offer standardized diagnostic and treatment approaches for allergic bronchopulmonary aspergillosis/mycosis to improve patient care and outcomes.
Aiming to streamline the diagnosis and management of allergic bronchopulmonary aspergillosis (ABPA) and allergic bronchopulmonary mycosis (ABPM), the International Society for Human and Animal Mycology (ISHAM) working group has released updated Delphi consensus guidelines as published in the “European Respiratory Journal”.
These guidelines, developed through expert collaboration, address advances in diagnostics and therapies that have emerged since the original recommendations were established a decade ago. They are based on the modified Delphi method, with consensus defined as ≥70% agreement for managing ABPA and ABPM in adults and children. "Recommend" was used for ≥70% consensus, and "suggest" for <70%.
The new guidelines recommend screening adults with asthma for Aspergillus fumigatus sensitization and suggest testing difficult-to-treat pediatric asthma patients. ABPA diagnosis is advised for those with pertinent clinical and radiological characteristics, alongside key lab markers (such as raised total IgE and fungal-specific IgG). In cases where ABPA-like symptoms occur without Aspergillus fumigatus sensitization, ABPM should be considered, with corroboration through repeated fungal growth from sputum samples.
For treatment, the guidelines encourage oral Prednisolone or Itraconazole first-line therapy for acute ABPA, and a combination of the two for persistent flare-ups. Treatment is not recommended for asymptomatic ABPA patients. An objective, multidimensional tool has also been introduced to assess treatment response, aiming to enhance both clinical care and research consistency.
European Respiratory Journal
Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses
Ritesh Agarwal et al.
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