PDF(Pubmed)
Abstract：
BACKGROUND: The International Society for Human and Animal Mycology (ISHAM) working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) a decade ago. There is a need to update these recommendations due to advances in diagnostics and therapeutics.
METHODS: An international expert group was convened to develop guidelines for managing ABPA (caused by Aspergillus spp.) and allergic bronchopulmonary mycosis (ABPM; caused by fungi other than Aspergillus spp.) 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%, respectively.
RESULTS: We recommend screening for A. fumigatus sensitisation using fungus-specific IgE in all newly diagnosed asthmatic adults 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 sensitisation and serum total IgE ≥500 IU·mL-1 and two of the following: fungal-specific IgG, peripheral blood eosinophilia or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normal A. 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.
CONCLUSIONS: We have framed consensus guidelines for diagnosing, classifying and treating ABPA/M for patient care and research.
METHODS: An international expert group was convened to develop guidelines for managing ABPA (caused by Aspergillus spp.) and allergic bronchopulmonary mycosis (ABPM; caused by fungi other than Aspergillus spp.) 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%, respectively.
RESULTS: We recommend screening for A. fumigatus sensitisation using fungus-specific IgE in all newly diagnosed asthmatic adults 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 sensitisation and serum total IgE ≥500 IU·mL-1 and two of the following: fungal-specific IgG, peripheral blood eosinophilia or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normal A. 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.
CONCLUSIONS: We have framed consensus guidelines for diagnosing, classifying and treating ABPA/M for patient care and research.
摘要：
背景：ISHAM工作组在近十年前提出了治疗过敏性支气管肺曲霉病（ABPA）的建议。由于诊断和治疗方面的进步,需要更新这些建议。
方法：召集了一个国际专家组，以制定管理ABPA（由曲霉属引起的。)和过敏性支气管肺真菌病(ABPM，除曲霉属以外的真菌.）在成人和儿童中使用修改后的Delphi方法（两次在线回合和一次面对面会议）。我们将共识定义为≥70%的同意或分歧。当共识≥70%和<70%时，使用术语“推荐”和“建议”。
结果：我们建议在三级治疗的所有新诊断的成人哮喘患者中使用真菌特异性IgE筛查烟曲霉致敏性，但仅限于难以治疗的哮喘儿童。我们建议在有易感条件或符合临床放射学表现的患者中诊断ABPA，强制性证明了真菌致敏和血清总IgE≥500IU·mL-1以及以下两种：真菌特异性IgG，外周血嗜酸性粒细胞增多,或暗示性成像。在具有ABPA样表现但烟曲霉IgE正常的患者中考虑ABPM。此外,诊断ABPM需要痰中致病真菌的反复生长。我们不建议常规治疗无症状的ABPA患者。我们建议口服泼尼松龙或伊曲康唑单药治疗急性ABPA（新诊断或恶化），仅使用泼尼松龙和伊曲康唑联合治疗复发性ABPA加重。我们设计了一个客观的多维标准来评估治疗反应。
结论：我们制定了诊断的共识指南，分类，并治疗ABPA（M）用于患者护理和研究。
方法：召集了一个国际专家组，以制定管理ABPA（由曲霉属引起的。)和过敏性支气管肺真菌病(ABPM，除曲霉属以外的真菌.）在成人和儿童中使用修改后的Delphi方法（两次在线回合和一次面对面会议）。我们将共识定义为≥70%的同意或分歧。当共识≥70%和<70%时，使用术语“推荐”和“建议”。
结果：我们建议在三级治疗的所有新诊断的成人哮喘患者中使用真菌特异性IgE筛查烟曲霉致敏性，但仅限于难以治疗的哮喘儿童。我们建议在有易感条件或符合临床放射学表现的患者中诊断ABPA，强制性证明了真菌致敏和血清总IgE≥500IU·mL-1以及以下两种：真菌特异性IgG，外周血嗜酸性粒细胞增多,或暗示性成像。在具有ABPA样表现但烟曲霉IgE正常的患者中考虑ABPM。此外,诊断ABPM需要痰中致病真菌的反复生长。我们不建议常规治疗无症状的ABPA患者。我们建议口服泼尼松龙或伊曲康唑单药治疗急性ABPA（新诊断或恶化），仅使用泼尼松龙和伊曲康唑联合治疗复发性ABPA加重。我们设计了一个客观的多维标准来评估治疗反应。
结论：我们制定了诊断的共识指南，分类，并治疗ABPA（M）用于患者护理和研究。
