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International Society for Human and Animal Mycology (ISHAM) working group diagnostic criteria for allergic bronchopulmonary aspergillosis

International Society for Human and Animal Mycology (ISHAM) working group diagnostic criteria for allergic bronchopulmonary aspergillosis
Predisposing conditions (one must be present):*
Asthma
Cystic fibrosis
Obligatory criteria (both must be present):
Serum IgE levels against Aspergillus fumigatus ≥0.35 kU/L (preferred) or Aspergillus skin test positivity.
Total IgE concentration ≥500 international units/mL
Other criteria (at least two must be present):
Elevated serum Aspergillus IgG by immunoassay or lateral flow assayΔ
Radiographic pulmonary opacities consistent with ABPA◊
Blood eosinophil count >500 cells/microL (may be historical)§

ABPA: allergic bronchopulmonary aspergillosis; IgE: immunoglobulin E.

* Rarely, ABPA is identified in the absence of asthma or cystic fibrosis based on the presence of all other criteria. COPD and post-tuberculous fibrocavitary disease may be predisposing conditions.

¶ An IgE value <500 international units/mL may be acceptable if all the other criteria (Aspergillus IgG, imaging findings, and eosinophil count) are fulfilled

Δ Measuring Aspergillus serum precipitins is no longer favored due to decreased sensitivity compared with direct IgG measurement

◊ High-resolution chest CT (HRCT) is preferred for establishing the diagnosis. Findings consistent with ABPA on HRCT include bronchiectasis, mucus plugging and high-attenuation mucus. Fleeting opacities on serial chest radiograph also fulfill this criterion.

§ Blood eosinophil counts can be strongly diminished by use of systemic glucocorticoids or biologic agents for the treatment of refractory asthma.
References:
  1. Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy 2013; 43:850.
  2. Agarwal R, Sehgal IS, Dhooria S, Aggarwal AN. Developments in the diagnosis and treatment of allergic bronchopulmonary aspergillosis. Expert Rev Respir Med 2016; 10:1317.
  3. Agarwal R, Sehgal IS, Muthu V, et al. Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses. Eur Respir J 2024; 63(4):2400061.
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