Evidence-Based Guidelines for the Management of Allergic Bronchopulmonary Aspergillosis (ABPA) in Children and Adolescents with Asthma

Mathew, Joseph L; Kumar, Ketan; Agrawal, Sheetal; Bafna, Sanjay; Bhatt, Sonia; Chatterjee, Pallab; Chithambaram, N. S.; Das, Rashmi Ranjan; Gupta, Hema; Gupta, Saurabh; Jat, Kana Ram; Kalyan, Pawan; Kapoor, Rohit; Kaur, Hardeep; Kaur, Jasmeet; Kaur, Satnam; Kulkarni, Suhas; Rawat, Sanjiv Singh; Saxena, Vivek; Singh, Anita; Sivabalan, Somu; Srivastava, Shetanshu; Tayal, Anshula

doi:10.1007/s12098-023-04592-y

Cited by 18 publications

(3 citation statements)

References 28 publications

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“…Growth retardation with the use of systemic corticosteroids and the erratic bioavailability of azoles due to age-related changes in cytochrome P450 enzymes are of primary concern [ 188 ]. There are no randomised trials on the treatment of ABPA in children [ 189 ]. Omalizumab and mepolizumab are approved for asthma therapy in the age group ≥6 years [ 190 , 191 ], while other biological agents can be used in those ≥12 years old.…”

Section: Resultsmentioning

confidence: 99%

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Agarwal,

Sehgal,

Muthu

et al. 2024

Eur Respir J

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BackgroundThe ISHAM working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) nearly a decade ago. There is a need to update these recommendations due to advances in diagnostics and therapeutics.MethodsAn international expert group was convened to develop guidelines for managing ABPA (caused byAspergillusspp.) and allergic bronchopulmonary mycosis (ABPM, fungi other thanAspergillusspp.) in adults and children using a modified Delphi method (two online rounds and one in-person meeting). We defined consensus as ≥70% agreement or disagreement. The terms “recommend” and “suggest” are used when the consensus was ≥70% and <70%.ResultsWe recommend screening forA. fumigatussensitization using fungus-specific IgE in all newly diagnosed adult asthmatics at tertiary care but only difficult-to-treat asthmatic children. We recommend diagnosing ABPA in those with predisposing conditions or compatible clinico-radiological presentation, with a mandatory demonstration of fungal sensitization and serum total IgE ≥500 IU·mL−1and two of the following: fungal-specific IgG, peripheral blood eosinophilia, or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normalA. fumigatus-IgE. Additionally, diagnosing ABPM requires repeated growth of the causative fungus from sputum.We do not routinely recommend treating asymptomatic ABPA patients. We recommend oral prednisolone or itraconazole monotherapy for treating acute ABPA (newly diagnosed or exacerbation), with prednisolone and itraconazole combination only for treating recurrent ABPA exacerbations. We have devised an objective multidimensional criterion to assess treatment response.ConclusionWe have framed consensus guidelines for diagnosing, classifying, and treating ABPA(M) for patient care and research.

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Section: Resultsmentioning

confidence: 99%

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Agarwal,

Sehgal,

Muthu

et al. 2024

Eur Respir J

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“…94 However, more data and randomized trials are essential. 95 ABPA sans asthma and allergic bronchopulmonary mycoses ([ABPM], ABPA-like syndrome caused by fungi other than A. fumigatus) are less frequently encountered entities and are managed like ABPA. However, before treating ABPM with antifungal agents, the causative fungi should be identified.…”

Section: Treatment Of Allergic Bronchopulmonary Aspergillosis In Spec...mentioning

confidence: 99%

Clinical Manifestation and Treatment of Allergic Bronchopulmonary Aspergillosis

Agarwal,

Muthu,

Sehgal

2023

Semin Respir Crit Care Med

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Allergic bronchopulmonary aspergillosis (ABPA) is a complex hypersensitivity reaction to airway colonization by Aspergillus fumigatus in patients with asthma and cystic fibrosis. The pathophysiology of ABPA involves a complex interplay between the fungus and the host immune response, which causes persistent inflammation and tissue damage. Patients present with chronic cough, wheezing, and dyspnea due to uncontrolled asthma. Characteristic symptoms include the expectoration of brownish mucus plugs. Radiographic findings often reveal fleeting pulmonary infiltrates, bronchiectasis, and mucus impaction. However, the definitive diagnosis of ABPA requires a combination of clinical, radiological, and immunological findings. The management of ABPA aims to reduce symptoms, prevent disease progression, and minimize the future risk of exacerbations. The treatment approach involves systemic glucocorticoids or antifungal agents to suppress the inflammatory response or fungal growth and prevent exacerbations. Biological agents may be used in patients with severe disease or glucocorticoid dependence. This review provides an overview of the clinical manifestations and current treatment options for ABPA.

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“…In addition to the process of guideline development, this issue presents the product as well. The first guideline using the zero-cost methodology was developed on behalf of the Indian Academy of Pediatrics National Respiratory Chapter (IAPNRC), on the somewhat difficult subject of Allergic Bronchopulmonary Aspergillosis (ABPA) in children with asthma [ 8 ]. This evidence-based guideline, using contemporary methodology [ 9 – 11 ] addressed seven prioritized clinical questions and offers six formal recommendations with their strength and certainty of evidence.…”

mentioning

confidence: 99%

Evidence-Based Guidelines for the Management of Allergic Bronchopulmonary Aspergillosis (ABPA) in Children and Adolescents with Asthma

Cited by 18 publications

References 28 publications

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Clinical Manifestation and Treatment of Allergic Bronchopulmonary Aspergillosis

Evidence, Experience, and Eminence: Building Blocks for Pediatric Pulmonology Practice and Research in India

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