Molecular diagnosis approach in allergic bronchopulmonary aspergillosis

Abstract

Allergic bronchopulmonary aspergillosis (ABPA) is a disease that occurs in patients with asthma or cystic fibrosis who have positive skin tests for immediate hypersensitivity against Aspergillus fumigatus, and elevated levels of serum IgE and IgG antibodies against fungal‑specific antigen,​​ determined by fluoroimmunoenzymatic assay. In this review, we present the diagnostic criteria for ABPA revised in the last decade by several expert groups. The officially recognized molecular allergens of Aspergillus fumigatus used in commercially available singleplex and multiplex immunoassays for the determination of serum specific IgE are mitogillin Asp f 1 from ribonuclease family, fibrinogen binding-protein Asp f 2, peroxisomal membrane protein Asp f 3, group 4 fungal allergen Asp f 4, and Mn superoxide dismutase Asp f 6. The detailed evaluation of IgE sensitization molecular profiles, using the panel of recombinant allergenic components of Aspergillus fumigatus, is useful in clinical practice to identify genuine versus cross-reactive sensitization in patients sensitized to Aspergillus fumigatus, including patients with comorbid atopic dermatitis and sensitization to other fungi with cross-reactive allergenic components, for an accurate molecular allergy diagnosis of ABPA, and to distinguish ABPA from asthma with Aspergillus fumigatus sensitization without ABPA.