Fumigatus-specific IgE Research Articles

EQUAL ABPA Score 2024: A Tool to Measure Guideline Adherence for Managing Allergic Bronchopulmonary Aspergillosis.

Allergic bronchopulmonary aspergillosis (ABPA) is a complex lung disease associated with significant morbidity. The ABPA Working Group (AWG) of the International Society for Human and Animal Mycology (ISHAM) revised their management guidelines in 2024, but there is currently no standardised tool to assess adherence to these recommendations. We extracted key recommendations from the updated 2024 ISHAM-AWG guidelines, focusing on critical areas: screening and diagnosis of ABPA, managing acute and treatment-dependent ABPA, and monitoring treatment response. Each item was assigned a score ranging from zero to three. We assigned negative scores to interventions not recommended by the guidelines. We identified 38 items indicative of optimal clinical care for patients with ABPA. The score for screening asthmatics for ABPA was set at three points. For diagnosing ABPA, 16 items were included, with a score ranging from 12 to 16 points, depending on the specific components used (predisposing conditions, serum A. fumigatus-specific IgE and IgG, serum total IgE, blood eosinophil count and chest computed tomography). The management of acute ABPA comprised 11 items, with a maximum score of three points. For treatment-dependent ABPA, there were nine items (scores ranging from -3 to 6). Follow-up care comprised 10 items with a maximum score of 10-13 points, covering imaging, spirometry, testing serum total IgE levels and therapeutic drug monitoring. The EQUAL ABPA score has been developed as a comprehensive tool to quantify guideline adherence. Future studies will evaluate to which extent guideline adherence is associated with improved clinical outcomes for patients with ABPA.

Population prevalence of aspergillus sensitization and allergic bronchopulmonary aspergillosis in COPD subjects in North India.

Sensitization to Aspergillus fumigatus (AS) has been recently described in chronic obstructive pulmonary disease (COPD) patients. However, there is no data on the community prevalence of AS in COPD. To assess the prevalence of AS among COPD subjects. The secondary objectives were to (1) assess the prevalence of allergic bronchopulmonary aspergillosis (ABPA) in COPD and (2) compare the lung function in COPD subjects with and without AS. We conducted a cross-sectional study in rural (29 villages) and urban (20 wards) communities in North India. We identified individuals with respiratory symptoms (IRS) through a house-to-house survey using a modified IUATLD questionnaire. We then diagnosed COPD through specialist assessment and spirometry using the GOLD criteria. We assayed A.fumigatus-specific IgE in COPD subjects. In those with A. fumigatus-specific IgE ≥0.35 kUA/L (AS), ABPA was diagnosed with raised serum total IgE and raised A.fumigatus-specific IgG or blood eosinophil count. We found 1315 (8.2%) IRS among 16,071 participants >40 years and diagnosed COPD in 355 (2.2%) subjects. 291 (82.0%) were men and 259 (73.0%) resided in rural areas. The prevalence of AS and ABPA was 17.7% (95% CI, 13.9-21.8) and 6.6% (95% CI, 4.4-8.8). We found a lower percentage predicted FEV1 in COPD subjects with AS than those without (p =.042). We found an 18% community prevalence of AS in COPD subjects in a specific area in North India. Studies from different geographical areas are required to confirm our findings. The impact of AS and ABPA on COPD requires further research.

Allergic bronchopulmonary aspergillosis with low serum IgE: a case report

Here, we reported a case of delayed diagnosis of allergic bronchopulmonary aspergillosis (ABPA) with low serum IgE and normal Aspergillus fumigatus-specific IgE levels. During the course of the disease, the patient (female, 55 years old) had imaging manifestation of mass shadow and significant elevation of carcinoembryonic antigen, leading to suspicion of a lung tumor. Later, transbronchial lung biopsy tissue culture showed Aspergillus fumigatus. Combined with the history, clinical characteristics and imaging, she was diagnosed with allergic bronchopulmonary aspergillosis combined with invasive pulmonary aspergillosis. As the diagnostic criteria for ABPA do not cover all patients with ABPA, in rare cases where immunological evidence is insufficient, a combination of clinical and imaging features is required for early diagnosis and treatment.

Fractional exhaled nitric oxide, a potential biomarker for evaluating glucocorticoids treatment and prognosis in allergic bronchopulmonary aspergillosis

BackgroundAllergic bronchopulmonary aspergillosis (ABPA) is characterized by enhanced TH2 inflammatory response. Fractional exhaled nitric oxide (FeNO) measurement has been used as a valuable tool in predicting the development and management of asthma, another typical TH2 inflammation. However, the clinical significance of FeNO in ABPA remains unclear. ObjectiveTo investigate the association between FeNO and the prognosis of patients with ABPA to provide a basis for the use of FeNO in evaluating the efficacy of glucocorticoids in ABPA treatment. MethodsThis study comprised 2 parts; 58 patients were enrolled in the retrospective study. Clinical indexes in patients with different prognoses were compared, and receiver operating characteristic curve analysis was used to determine the threshold value. The prospective observational study involved 61 patients who were regularly followed up at 4 to 6 weeks and 6 months since the initial treatment. Patients were grouped on the basis of baseline FeNO values; correlation analysis was performed in the clinical data. ResultsDifferent prognoses were observed between patients with high and low baseline FeNO values, with a threshold value of 57 parts per billion. The percentage of Aspergillus fumigatus-specific IgE, percentage of positive A fumigatus-specific IgG, and relapse/exacerbation rate differed significantly between the high and low FeNO groups. Patients with higher FeNO needed longer treatment duration and showed shorter interval between glucocorticoid withdrawal and the next relapse/exacerbation. ConclusionOur findings indicate that the level of FeNO is associated with the prognosis of ABPA. It can serve as an independent and valuable biomarker for evaluating the effectiveness of glucocorticoid treatment.

High attenuation mucus in bronchi with allergic bronchopulmonary mycosis.

High-attenuation mucus (HAM) is a specific manifestation of allergic bronchopulmonary mycosis (ABPM) on chest computed tomography (CT). To compare the diagnostic accuracy of the two definitions of HAM and to clarify the clinical and radiographic characteristics of HAM-positive and HAM-negative ABPM. CT images at the diagnosis of ABPM using Asano's criteria were retrospectively analysed. In Study #1, radiographic data obtained using the same CT apparatus in a single institute were analysed to determine the agreement between the two definitions of HAM: a mucus plug that is visually denser than the paraspinal muscles or that with a radiodensity ≥70 Hounsfield units. In Study #2, HAM was diagnosed by comparison with the paraspinal muscles in patients with ABPM reporting to 14 medical institutes in Japan. In Study #1, 93 mucus plugs from 26 patients were analysed. A substantial agreement for HAM diagnosis was observed between the two methods, with a κ coefficient of 0.72. In Study #2, 60 cases of ABPM were analysed; mucus plugs were present in all cases and HAM was diagnosed in 45 (75%) cases. The median A. fumigatus-specific IgE titre was significantly lower in HAM-positive patients than in HAM-negative patients (2.5 vs. 24.3 UA /mL, p = .004). Nodular shadows were observed more frequently in the airways distal to HAM than in those distal to non-HAM mucus plugs (59% vs. 32%, p < .001). In conclusion, agreement between the two methods to diagnose HAM was substantial. HAM was associated with some immunological and radiographic characteristics, including lower levels of sensitization to A. fumigatus and the presence of distal airway lesions.

Spectrum of sensitization to aeroallergens as one of the risk factors for uncontrolled severe asthma

BACKGROUND: Asthma is considered one of the urgent medical and social problems of the XXI century. In recent years, not only an increase in the incidence, but also an increase in the prevalence of severe forms of asthma has been noted in all countries of the world. The effect of the sensitization spectrum on the severity and level of asthma control has not been studied enough.&#x0D; AIM: Evaluate the importance of sensitization spectrum to aeroallergens in severe asthma patients as indicators for disease exacerbation risk.&#x0D; MATERIALS AND METHODS: Single-center cross-sectional study at North-Western State Medical University n.a. I.I. Mechnikov. Examined 93 severe asthma patients. Analysis covered demographic traits, comorbidities, hereditary history, living conditions, exacerbations, past-year hospitalizations, medications, spirometry, and specific IgE presence for 10 aeroallergens.&#x0D; RESULTS: Aspergillus fumigatus specific IgE notably impacted asthma control. Disease exacerbation risk was 8.4 times higher with A. fumigatus sensitization. Multivariate logistic regression revealed higher risk with A. fumigatus sensitization (4.79), fixed obstruction (6.2), systemic steroids use (5.85), indoor mold exposure (4.45), and familial asthma history (2.53).&#x0D; CONCLUSION: A. fumigatus sensitization significantly influences asthma course and control, worsening prognosis. Targeted examination of patients measuring sIgE levels for common aeroallergens is necessary to identify control obstacles. The results of the study were previously reported at the All-Russian Congress on Medical Microbiology, Clinical Mycology and Immunology and published in the form of abstracts in the journal Problems in medical mycology, 2022, Vol. 24, No 2.

Unusual coexistence: Allergic bronchopulmonary aspergillosis and pulmonary tuberculosis- A rare case report

: Allergic Bronchopulmonary Aspergillosis (ABPA) is an allergic hypersensitivity reaction to the ubiquitous fungus Aspergillus that can cause inflammation and damage to the respiratory system. This condition predominantly occurs in individuals with long-standing airway disease, such as bronchial asthma or cystic fibrosis. While Acid-fast bacilli Mycobacterium tuberculosis causes tuberculosis (TB). ABPA and TB can coexist in the same patient. The coexistence of these two conditions can make the diagnosis and treatment more challenging. This is because some of the symptoms of ABPA, such as cough and wheezing, can be similar to those of TB, and both conditions can cause lung damage. A 21-year young male was admitted with a six-month history of low-grade fever, cough with expectoration, atypical chest pain, and progressive breathlessness. On examination, the patient had bilateral diffuse rhonchi with coarse crepitation, and his chest X-ray showed bilateral heterogeneous opacities with cavities in the left upper and middle zone. Further evaluation revealed a total serum IgE of 3074 IU/L (Normal &amp;#60;100) and elevated levels of Aspergillus fumigatus-specific IgE and IgG. A high-resolution CT of the thorax revealed bilateral upper lobes with tree-in-bud opacities and centrilobular nodules, leading to a diagnosis of ABPA. A sputum sample was sent for an AFB smear, which was positive.Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus fumigatus that most commonly affects people who have bronchial asthma or cystic fibrosis. However, diagnosis can be challenging as patients may not respond to standard treatment, and the symptoms can overlap with those of other respiratory diseases. Therefore, clinicians need to maintain a high index of suspicion for ABPA in at-risk patients and consider appropriate screening tests.This case highlights the rare co-existence of active pulmonary TB and ABPA, which can make diagnosis and treatment challenging. However, with appropriate management, including anti-tubercular treatment and corticosteroid therapy, the patient showed marked improvement in his condition. Clinicians should consider the possibility of multiple comorbidities in patients presenting with respiratory symptoms, and appropriate evaluation and management should be undertaken to achieve optimal outcomes.

Allergic bronchopulmonary aspergillosis with marked peripheral blood eosinophilia and pulmonary eosinophilia: A case report

Allergic bronchopulmonary aspergillosis (ABPA) is an immune-related pulmonary disease caused by sensitization of airway by Aspergillus fumigatus. The disease manifests as bronchial asthma and recurring pulmonary shadows, which may be associated with bronchiectasis. The diagnosis of ABPA mainly depends on serological, immunological, and imaging findings. Pathological examination is not necessary but may be required in atypical cases to exclude pulmonary tuberculosis, tumor, and other diseases through lung biopsy. An 18-year-old man presented with recurrent wheezing, cough, and peripheral blood eosinophilia. Chest computed tomography showed pulmonary infiltration. There was a significant increase in eosinophils in bronchoalveolar lavage fluid. There was no history of residing in a parasite-endemic area or any evidence of parasitic infection. Pathologic examination of bronchoalveolar lavage fluid excluded fungal and mycobacterial infections. The patient was receiving medication for comorbid diseases, but there was no temporal correlation between medication use and clinical manifestations, which excluded drug-induced etiology. Histopathological examination of lung biopsy specimen showed no signs of eosinophilic granulomatosis with polyangiitis, IgG4-related diseases, or tumors. The diagnosis of ABPA was considered based on the history of asthma and the significant increase in serum Aspergillus fumigatus-specific immunoglobulin (Ig)E. Eosinophil-related diseases were excluded through pathological biopsy, which showed typical pathological manifestations of ABPA. The possibility of ABPA should be considered in patients with poorly controlled asthma, especially those with eosinophilia, lung infiltration shadows, or bronchiectasis. Screening for serum IgE, Aspergillus fumigatus-specific IgE and IgG, and alveolar lavage can help avoid misdiagnosis.

The influence of &lt;i&gt;Aspergillus fumigatus&lt;/i&gt; micromycetes on immune response regulation in patients with asthma

Introduction. Aspergillus fumigatus is able not only to sensitize patients with atopy, but also to colonize the respiratory tract, remaining a constant source of allergens due to the small spore size and thermal tolerance. Currently, the role of micromycetes in the immunopathogenesis of asthma has been poorly studied. The objective was to evaluate the features of the immune response regulation in patients with allergic bronchopulmonary aspergillosis (ABPA) or asthma with sensitization to A. fumigatus. Materials and methods. There were enrolled 15 patients with ABPA, 10 patients with asthma with sensitization to A. fumigatus, 16 patients with asthma without sensitization to A. fumigatus. The control group consisted of 16 apparently healthy volunteers. All patients underwent a clinical and functional examination. The subpopulations of blood lymphocytes were assessed by flow cytometry. The A. fumigatus allergen was added to peripheral blood samples to evaluate the production of IFN, IL-10 and IL-13. The serum cytokine levels in cell culture supernatants, as well as total IgE, A. fumigatus-specific IgE (sIgE) as well as thymus and activation-regulated chemokine (TARC) level were measured by enzyme-linked immunosorbent assay. Results. Significantly higher serum levels of total IgE, A. fumigatus-specific sIgE and TARC were found in patients with ABPA and asthma with sensitization to A. fumigatus compared to patients with asthma without sensitization to A. fumigatus. The results of lymphocyte immunophenotyping revealed significant excess of memory Th2 cells and T-regulatory cells in all patients with asthma compared to the control group. The count of Tfh2 was higher but memory Th17.1 cells were lower in patients with sensitization to A. fumigatus compared to those of apparently healthy volunteers. Patients with ABPA had significantly higher count of memory Th2 cells and TARC level compared to patients with asthma sensitized to A. fumigatus. The increased activity of memory Th2 cells is confirmed by increased secretion of IL-13 and IL-10 following along with decreased IFN production in response to specific fungal allergen stimulation of blood cells compared to the patients with asthma and the control group. A positive correlation was revealed between the count of memory Th2 cells and the levels of sIgE, IgE, TARC, a negative correlation with FEV1. Conclusion. Thus, exposure to A. fumigatus significantly enhances the activity of memory Th2 cells in patients with asthma which can lead to severe disease course and development of allergic bronchopulmonary aspergillosis. The features of the immune response identified dictate a need for a personalized approach to choose therapeutic tactics in such patients.

Identification of distinct immunophenotypes in chronic pulmonary aspergillosis using cluster analysis.

Whether chronic pulmonary aspergillosis (CPA) has different immunophenotypes remains unknown. To identify different CPA immunophenotypes using cluster analysis. We used a subject-centred multivariate clustering approach without prior assumptions to identify CPA phenotypes. We retrospectively included the data of treatment-naïve subjects with CPA and excluded subjects with asthma and allergic bronchopulmonary aspergillosis (ABPA). We performed a scalable two-step cluster analysis using the log-likelihood distance measures to identify CPA phenotypes based on the blood immunological profile (total IgE, eosinophil count and Aspergillus-specific IgE and IgG). We included 351 CPA subjects and found two clusters. Cluster 2 (n=118) had significantly higher serum total IgE, peripheral blood eosinophil count, and serum A. fumigatus-specific IgE and IgG than cluster 1 (n=233). Cluster 2 subjects had a lower FEV1:FVC ratio on spirometry and were more likely to have a fungal ball (88 [74.6%] vs. 145 (62.2%), p=.023) on the CT thorax than cluster 1. After treatment discontinuation, cluster 2 had a longer median (interquartile range) time to relapse than cluster 1 (11.5 [7.3-27.4] vs. 4 [1.1-8.9]months, p=.005). We identified two distinct CPA phenotypes, type-2 dominant and non-type-2, with different clinical and radiological findings and treatment outcomes. Future studies should confirm our findings and investigate different treatment strategies based on CPA phenotypes.

Comparison of Aspergillus-specific antibody cut-offs for the diagnosis of aspergillosis.

Aspergillus diseases are frequently encountered in patients who are immunocompromised. Without a prompt diagnosis, the clinical consequences may be lethal. Aspergillus-specific antibodies have been widely used to facilitate the diagnosis of Aspergillus diseases. To date, universally standardized cut-off values have not been established. This study aimed to investigate the cut-off values of Aspergillus-specific antibodies and perform a narrative review to depict the geographic differences in the Taiwanese population. We analyzed enrolled 118 healthy controls, 29 patients with invasive aspergillosis (IA), chronic pulmonary aspergillosis (CPA), and allergic bronchopulmonary aspergillosis (ABPA) and 99 with disease control, who were tested for Aspergillus fumigatus and Aspergillus niger-specific IgG and IgE using ImmunoCAP. 99 participants not fulfilling the diagnosis of IA, CPA, and ABPA were enrolled in the disease control group. The duration of retrieval of medical records from June 2018 to September 2021. Optimal cut-offs and association were determined using receiver operating characteristic curve (ROC) analysis. We found that patients with CPA had the highest A. fumigatus-specific IgG levels while patients with ABPA had the highest A. fumigatus-specific IgE, and A. niger-specific IgG and IgE levels. In patients with CPA and ABPA, the optimal cut-offs of A. fumigatus-specific IgG and A. niger-specific IgG levels were 41.6, 40.8, 38.1, and 69.9 mgA/l, respectively. Geographic differences in the cut-off values of A. fumigatus-specific IgG were also noted. Specifically, the levels were different in eco-climatic zones. We identified the optimal cut-offs of Aspergillus-specific antibodies to facilitate a precise diagnosis of aspergillosis. The observed geographic differences of the antibody levels suggest that an eco-climatic-specific reference is needed to facilitate a prompt and accurate diagnosis of aspergillosis.

P501 Aspergillus fumigatus complicates one third of the patients with suspected bronchial asthma or pulmonary tuberculosis: Clinical validation of indigenously developed diagnostic kits

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectives Aspergillus fumigatus, an opportunistic fungus, causes complications in about 5%-20% of bronchial asthma and about 26% of pulmonary tuberculosis patients. Detection of Aspergillus fumigatus specific IgG and IgE antibodies in the patient serum is an excellent tool to screen for Aspergillus sensitization early on to employ anti-fungal drugs in the clinical management to stall the progression of lung fibrosis.MethodsNovel indigenous AfuPEPLISA assays were developed for the detection of specific IgG and IgE, based on the 12 amino acid long synthetic peptide epitope of Asp f1, an 18 kDa major allergen/antigen. The novel diagnostic kits were manufactured at a licensed GMP facility under a test license. Independent validation of the kits was pursued at PGIMER and VPCI hospitals in suspected bronchial asthma patients (n = 1307), and the diagnostic efficiency was compared with currently used ImmunoCAP assay.ResultsThe diagnostic specificity and sensitivity were found to be 95.7% and 89.8%, respectively, for IgG; and 94.2% and 70%, respectively for IgE AfuPEPLISA, and were not significantly different from ImmunoCAP assay. Screening of the suspected patients of pulmonary tuberculosis (PTB) at RBIPMT Hospital for the presence of A. fumigatus specific IgG and IgE antibodies was pursued using AfuPEPLISA kits. A total of 82 out of 254 suspected PTB patients (32.3%) were seropositive in agreement with the previous reports.See Figures 1 and 2 below.ConclusionThe study inferred that indigenously developed AfuPEPLISA kits are an economically viable option to integrate in the clinical management of patients with suspected bronchial asthma or PTB for efficient diagnosis of Aspergillus sensitization.

P410 Aspergillus fumigatus sensitization among the patients with chronic obstructive pulmonary disease (COPD)— a cross sectional study

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMObjectivesAllergic bronchopulmonary aspergillosis (ABPA) caused by hypersensitivity to A. fumigatus complicates the course of asthma. Fungal sensitization due to A. fumigatus among asthmatic patients and their progression to ABPA is well studied. Similar data on Aspergillus sensitization among patients with COPD and their progression are still not well established. The objective of this study was to evaluate the Total serum IgE (TIgE) and A. fumigatus specific IgE (Af sp IgE) levels among patients with COPD.MethodA total of 100 stable patients with COPD above 40 years of age from the Department of Pulmonary Medicine were included. TIgE and Af sp IgE levels were detected using VIDAS total IgE assay and M3 ImmunoCap with Phadia 100 respectively. The subjects were grouped into three (TIgE <500 IU/l, 500-1000 IU/l, and >1000 IU/l) based on the TIgE values. They were also categorized based on Af sp IgE levels as sensitization likely (AS ≥0.35 kUA/l), sensitization indeterminate (AI 0.1-0.35 kUA/l), and sensitization unlikely (AU ≤0.1 kUA/l). This categorization was based on the kit manufacturer's guidelines that sensitization is unlikely with specific IgE <0.1 kUA/l and the proposed ISHAM ABPA working group criteria of >0.35 kUA/l for diagnosis of sensitization. A comparison of Asf sp IgE with TIgE was done using the Fischer exact test.ResultAmong 100 patients, the prevalence of elevated TIgE [>150 IU/l (kit cutoff)] and Aspergillus sensitization [Af Sp IgE >0.35kUA/l (ISHAM cutoff)] was 47% and 6%, respectively. A total of 5% of subjects satisfied the criteria for serological ABPA. The results of the comparison of Asf sp IgE with total IgE using the Fischer exact test are given in Table 1.AS category: TIgE was >1000 IU/l in 5 (83.3%) of the 6 subjects. One (16.7%) had between 500-1000 IU/l. None of them had TIgE <500IU/l. Aspergillus sensitization was higher in 3/5 subjects with TIgE >1000 IU/ml (Asf sp IgE values of 2.55KUA/l, 12KUA/l, 14KUA/l, 0.38KUA/l, and 0.45KUA/l) compared with the one subject with TIgE <1000IU/l (Asf sp IgE of 0.73KUA/l). The clinical characteristics of subjects in the AS category is given in Table 2.AI category: A total of 7 (50%) of the 14 subjects had the TIgE value >1000 IU/l, 5 (35.7%) had the TIgE between 500-1000 IU/l, and 2 subjects had the TIgE <500 IU/l.AU category: In all, 1 (1.25%) had the TIgE value >1000 IU/l, 5 (6.25%) had the TIgE between 500-1000 IU/l. TIgE was <500 IU/l in 74 (92.5%) subjects.ConclusionThe study results suggest the co-existence of COPD and Aspergillus sensitization/ABPA. Patients in the AI group (Af sp IgE level 0.1-0.35 kUA/l) must be evaluated and monitored to prevent the progression of the disease. Studies involving a larger patient population are warranted.

Significance of aspergillus fumigatus-specific IgG in the diagnosis of allergic bronchopulmonary aspergillosis

The data of 18 patients with allergic bronchopulmonary aspergillosis (ABPA) who received aspergillus fumigatus-specific IgG detection from 2015 to 2021 in Peking University Third Hospital were retrospectively analyzed. Among them, 11 were male and 7 were female, aged 18-79 years. All patients had a history of asthma or symptoms of cough and asthma, and aspergillus fumigatus-specific IgE was positive; 16 patients had total serum IgE>500 U/ml, of which 13 patients had total serum IgE>1 000 U/ml. Among other diagnostic indicators, peripheral blood eosinophils were >0.5×109/L in 16 cases; lung CT showed bronchiectasis in 15 cases; serum aspergillus fumigatus-specific IgG was positive (>120 AU/ml) in 10 cases. There was no significant difference in serum total IgE level, peripheral blood eosinophil count, and bronchiectasis ratio between positive and negative cases of aspergillus fumigatus-specific IgG (all P>0.05). In this study, the positive rate of aspergillus fumigatus-specific IgG in patients with ABPA was more than 50%, which has auxiliary value in the diagnosis of ABPA.

Expression of galectin-13 in allergic diseases involving airway, skin and mucous membranes

To detect the expression of galectin-13 in allergic diseases and provide a new way for the diagnosis and treatment of allergic diseases. A retrospective analysis method was used to screen 216 patients with allergic diseases with house dust mites or aspergillus as allergens who visited the Department of Allergy and Department of Respiratory of Tongji Hospital attached Tongji Medical College, Huazhong University of Science and Technology from March 2018 to May 2021. These allergic diseases included allergic asthma, allergic bronchopulmonary aspergillosis, allergic rhinitis, allergic conjunctivitis, atopic dermatitis, allergic urticaria. 25 subjects without underlying diseases were selected as healthy controls. The galectin-13 content in serum in each group were detected, and the Pearson correlation was used to determine the correlation between the galectin-13 content in serum in each group and blood eosinophil count, blood specific IgE, the score scale of allergic disease. The expression of Galectin-13 was increased in allergic asthma group (71.44±39.44) pg/ml, allergic bronchopulmonary aspergillosis group (100.10±47.62) pg/ml, allergic rhinitis group (54.11±24.81) pg/ml and dermatitis group (44.12±19.51) pg/ml. The expression of galectin-13 was not significantly increased in allergic urticaria group (32.75±10.29) pg/ml and the allergic conjunctivitis group (30.55±9.87) pg/ml. The galectin-13 content in serum, was positively correlated with blood eosinophil count(rs=0.54, P<0.001) and house dust mite specific IgE (rs=0.51, P<0.001) in allergic asthma group, and was positively correlated with blood eosinophil count(rs=0.63, P=0.025) and aspergillus fumigatus specific IgE (rs=0.58, P=0.046) in allergic bronchopulmonary aspergillosis group. It was positively correlated with blood eosinophil count (rs=0.52, P=0.000 2) and house dust mite specific IgE (rs=0.41, P=0.005) in allergic rhinitis group. In allergic conjunctivitis group, the expression of galectin-13 was positively correlated with conjunctivitis symptom score (rs=0.47, P=0.048). In atopic dermatitis group, the expression of galectin-13 was positively correlated with blood eosinophil count (rs=0.58, P<0.001) and house dust mite specificity IgE (rs=0.47, P=0.002). In allergic urticaria group, the expression of galectin-13 was not significantly correlated with blood eosinophil count or house dust mite specific IgE. Galectin-13 may be related to the occurrence and progress of allergic diseases and may be involved in the occurrence of eosinophilic inflammation.

Epidemiology and outcomes of allergic bronchopulmonary aspergillosis in the elderly.

The prevalence and outcomes of allergic bronchopulmonary aspergillosis (ABPA) in the elderly remain unknown. We reviewed our database to identify the proportion of subjects diagnosed with ABPA at ≥60years of age (ABPA-elderly). We compared the clinical features, treatment and outcomes of ABPA-elderly versus the non-elderly (ABPA diagnosed at <60years of age). Between 2007 and 2019, we encountered 810 ABPA subjects with a mean age of 34.9years (49.4% women). Of these, 43 (5.3%) were aged ≥60years (ABPA-elderly). There was a trend towards lower median (interquartile range [IQR]) serum total IgE (4900 [2659-10000] vs. 7156 [23360-11963] IU/mL; P=.06) and Aspergillus fumigatus-specific IgE (12.3 [4.8-29.6] vs. 22.4 [7.7-41.5] kUA/L; P=.06) in the elderly than the non-elderly. Eosinophil counts were similar in the two groups. The median [IQR] number of segments involved by bronchiectasis (5 [2-9] vs. 7 [4-11]) was significantly lower in the ABPA-elderly (P=.001). The proportion of subjects experiencing ABPA exacerbations was significantly (P=.047) lower in the elderly (25.6%) vs. the non-elderly (40.8%). There was also a tendency towards a lower mean number of exacerbations in the elderly (155 vs. 208 exacerbation per 1000 person-years) than the non-elderly (P=.09). There was also a trend towards longer mean time to first exacerbation in the ABPA-elderly than the non-elderly (1612 vs. 1159days). ABPA was uncommon in the elderly. The bronchiectasis is less extensive with a trend towards lower immunological severity and fewer exacerbations in the elderly than the non-elderly subjects with ABPA.

Analysis of four cases with congenital pulmonary airway malformation complicated by chronic pulmonary aspergillosis

Objective: To investigate the clinical characteristics, treatment and prognosis of congenital pulmonary airway malformation (CPAM) complicated with chronic pulmonary aspergillosis (CPA) in children. Methods: The clinical manifestation, laboratory test, radiological feature, treatment and prognosis of 4 pediatric patients diagnosis of CPAM with CPA ascertained between March 2016 and April 2020 at the Department of No.2 Respiratory Medicine and Thoracic Surgery of Beijing Children's Hospital were retrospectively analyzed. Results: The 4 children included 2 males and 2 females, their age ranged from 9.9 to 13.6 years. Cough presented in 3 cases, hemoptysis in 2 cases, whereas in 1 case, pneumothorax was the first manifestation of the condition. Past history revealed multiple hospital admissions for pneumonia in 2 children and 1 with more than 2 episodes of wheezing. Aspergillus IgG was positive in 3 patients. Significantly elevated total IgE and fumigatus-specific IgE levels were noted in 2 children. CT demonstrated multiple cystic lesions, and fungal balls were seen in 2 children. They all underwent lobectomy and the lung tissue from the 4 children all demonstrated CPAM with Aspergillus infection. Aspergillus fumigatus was isolated from the abscess collected during operation in 1 patient. Postoperative, voriconazole was given in 3 children for 8 weeks, recurrence was observed in 2 children with characteristics of allergic bronchopulmonary aspergillosis. Voriconazole was given in one patient for 12 weeks with no recurrence. Conclusions: CPAM might be complicated with CPA,if there are hemoptysis, and fungal ball in chest CT, cautious preoperative examinations for microorganism are necessary. The necessity and duration of postoperative antifungal therapy need to be determined on individual basis.

Evaluation of an Aspergillus IgG/IgM lateral flow assay for serodiagnosis of fungal asthma in Uganda.

BackgroundDiagnosis of fungal allergies in asthma remains problematic in low-and middle-income countries due to non-availability of point-of-care testing. In this study, we aimed to evaluate the performance of an Aspergillus immunochromatographic technology (ICT) IgG/M lateral flow device (LFD) for the serological diagnosis of allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) among Ugandan adult asthmatics.Methods374 adult (aged ≥18years) asthmatics in the African Severe Asthma Program study, Ugandan site constituted the study population. ABPA and SAFS were diagnosed according to standard criteria. Asthmatics who did not meet the above criteria constituted a control group. The LFD tests were performed and read according to manufacturer’s instructions.ResultsABPA was found in 12/374 (3.2%) and SAFS in 60/374 (16%) participants. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for the Aspergillus ICT for the diagnosis of ABPA were 0.0%, 96.4%, 0.0% and 96.7% respectively, and for SAFS 6.7%, 97.1%, 30.8% and 84.5% respectively. False positive and negative rates were 3.5% and 3.2% for ABPA and 2.4% and 14.9% for SAFS, respectively. Patients with a positive LFD significantly had higher median Aspergillus fumigatus-specific IgE levels compared to those with negative LFD (median: 0.06 kUA/l VS 0.03 kUA/L, P = 0.011).ConclusionThe Aspergillus ICT IgG/M LFD had a poor diagnostic performance for the diagnosis of both ABPA and SAFS. Its greatest value may be in distinguishing chronic and allergic aspergillosis in Africa.

Which Are the Optimal Criteria for the Diagnosis of Allergic Bronchopulmonary Aspergillosis? A Latent Class Analysis

The ideal criteria for diagnosing allergic bronchopulmonary aspergillosis (ABPA) remain unknown because of the lack of a criterion standard. Latent class analysis using a probabilistic modeling technique can circumvent the need for a reference standard. To compare the diagnostic performance of various criteria used for evaluating ABPA. We prospectively enrolled consecutive cases of bronchial asthma and performed a series of investigations used for the diagnosis of ABPA. We used latent class analysis to analyze the performance of various existing and novel diagnostic criteria. Of the 543 subjects (mean age, 37 years; 319 women), 338 (62.2%) and 205 (37.8%) were labeled as "mild-to-moderate" and "severe" asthma cases, respectively. The subjects with severe asthma had a longer duration of asthma and a higher number of exacerbations in the previous year. The prevalence of Aspergillus fumigatus sensitization was 41% and 30%, using the A fumigatus-specific IgE and skin test, respectively. The prevalence of ABPA was 16%, using both the Rosenberg-Patterson and the International Society for Human and Animal Mycology (ISHAM)-ABPA Working Group criteria. The ISHAM criteria were slightly more sensitive (89% vs 81%) and specific (99% vs 98%) than the Patterson criteria. We obtained optimal diagnostic performance by altering the existing ISHAM criteria (serum total IgE >500 international units/mL, excluding the skin test, and using computed tomography of thorax instead of chest radiograph). The ISHAM-ABPA Working Group criteria were only marginally better than the Patterson criteria in diagnosing ABPA among patients with asthma younger than 66 years. The diagnostic performance however improved by modifying the prevailing ISHAM criteria, but with increased cost.

Analysis of serum polyunsaturated fatty acid metabolites in allergic bronchopulmonary aspergillosis

BackgroundThe importance of lipid mediators in allergic diseases has been long recognized, whereas little is known about their role in allergic bronchopulmonary aspergillosis (ABPA). We investigated whether lipid mediators are associated with ABPA.MethodsWe recruited 12 ABPA patients, 23 asthma patients and 12 healthy control in our study. Serum of 11 ABPA patients were collected before and following treatment. 36 polyunsaturated fatty acid metabolites were measured in serum samples by using liquid chromatography–mass spectrometry. This study was approved by the Ethics Committee of the First Affiliated Hospital of Guangzhou Medical University, with ethics number GYFYY-2016-73.ResultsLevels of arachidonic acid (AA), 15(S)-hydroxyeicosatetraenoic acid (HETE), 12(S)-HETE, 8(S)-HETE, 5(S)-HETE, LTB4, PGB2, 12(S)-hydroxyeicosapentaenoic acid (HEPE), 12-hydro-xyheptadecatrienoic acid (HHTrE) were significantly higher in ABPA patients than that in HC groups. Compared with asthma group, ABPA group expressed lower levels of 15(S)-hy-droperoxyeicosatetraenoic acid (HPETE), 5(S)-HPETE, 13(S)-hydroperoxyoctadecadienoic acid (HPODE) and 9(S)-HPODE. In APBA patients, AA level was positively correlated with serumtotal IgE (tIgE). The levels of 12(S)-HPETE, 15(S)-HEPE and 12(S)-HEPE correlated with Asp-ergillus fumigatus specific IgE(A. fumigatus sIgE) positively. Peripheral blood eosinophilia correlated with high levels of 12(S)-HETE and 15(S)-HETE. In addition, the serum levels of15(S)-HETE and 12(S)-HETE in ABPA subjects both declined with the decrease of tIgE, A. fumigatus sIgE and sIgG concentrations after treatment.ConclusionsWe present data regarding the role of polyunsaturated fatty acid metabolites in APBA for the first time. Most of the tested metabolites increased in ABPA when co-mpared with healthy controls and 15(S)-HETE and 12(S)-HETE may play a role in the pat-hogenesis of ABPA. These findings can provide new ideas for diagnosis, therapy and mon-itor of ABPA.