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eos counts in
ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS

Allergic bronchopulmonary aspergillosis (ABPA) is an eosinophilic lung condition caused by a hypersensitivity reaction to fungus Aspergillus fumigatus, typically occurring in patients with asthma or cystic fibrosis.1-3 ABPA is a subset of allergic bronchopulmonary mycosis (ABPM) and includes hypersensitivity reactions to Aspergillus fumigatus, other Aspergillus species, and other filamentous fungi.2,4 Prevalence of ABPA is estimated to be approximately 2.5% in adult patients with asthma and approximately 1-15% in patients with cystic fibrosis.5

EOS counts in ABPA diagnosis

Greater than or equal to 500 cells/µL for blood eosinophils

Diagnostic criteria for ABPA/ABPM without cystic fibrosis2:

Patients must meet 6 or more of the following 10 criteria for diagnosis of ABPA/ABPM:

  • Asthma or history of asthma
  • Blood eosinophilia (≥500 cells/µL)
  • Elevated serum immunoglobulin E (IgE) (≥417 IU/mL)
  • Specific IgE for filamentous fungi* or immediate cutaneous hypersensitivity to filamentous fungi on skin test*
  • Specific immunoglobulin G or precipitins for filamentous fungi*
  • Filamentous growth in bronchoalveolar lavage (BAL) or sputum cultures*
  • Presence of mucus plugs in central bronchi
    • History of mucus plug expectoration, or seen on computed tomography (CT) or bronchoscopy
  • Fungal hyphae in bronchial mucus plugs
  • CT imaging showing high-attenuation mucus in the bronchi
  • Central bronchiectasis on CT

*Fungi should be identical.

Early diagnosis and treatment of ABPA/ABPM is important for
prevention of long-term tissue damage4

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References:

  1. Wechsler ME. Pulmonary eosinophilic syndromes. Immunol Allergy Clin North Am. 2007;27(3):477-492.
  2. Asano K, Hebisawa A, Ishiguro T, et al. New clinical diagnostic criteria for allergic bronchopulmonary aspergillosis/mycosis and its validation. J Allergy Clin Immunol. 2021;147(4):1261-1268.e5.
  3. Vitte J, Ranque S, Carsin A, et al. Multivariate analysis as a support for diagnostic flowcharts in allergic bronchopulmonary aspergillosis: a proof-of-concept study. Front Immunol. 2017;8:1019.
  4. Fukutomi Y, Tanimoto H, Yasueda H, Taniguchi M. Serological diagnosis of allergic bronchopulmonary mycosis: progress and challenges. Allergol Int. 2016;65(1):30-36.
  5. Data and statistics on aspergillosis. Centers for Disease Control and Prevention. April 24, 2024. Accessed September 5, 2024. https://www.cdc.gov/aspergillosis/statistics