期刊
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
卷 2, 期 6, 页码 703-708出版社
ELSEVIER SCIENCE BV
DOI: 10.1016/j.jaip.2014.08.007
关键词
Allergic; Bronchopulmonar; Aspergillosis; Asthma; Mycosis; IgE; Azole
资金
- National Institutes of Health Clinical and Translational Award [UL1 TR000371]
- National Center for Advancing Translational Research Award [KL2 TR000370]
- Triological Society Research Career Development Award
- Ernest S. Bazley Grant
There remains a lack of agreement on diagnostic criteria and approaches to treatment of patients with allergic bronchopulmonary aspergillosis (ABPA). The results of a survey of American Academy of Allergy, Asthma, & Immunology members regarding these 2 issues are presented and compared for concordance with published recommendations. The literature was reviewed for pertinent reports, and an electronic survey was conducted of American Academy of Allergy, Asthma, & Immunology members and fellows regarding diagnostic criteria, numbers of patients evaluated for ABPA, and treatment approaches. From 508 respondents to the survey sent to 5155 US physicians in the American Academy of Allergy, Asthma, & Immunology database of members and fellows, 245 health professionals (48%) had treated at least 1 patient with ABPA in the previous year. For the diagnosis of ABPA, there was a difference in the threshold concentration of total serum IgE because 44.9% used >= 417 kU/L, whereas 42.0% used >= 1000 kU/L. Analysis of these findings suggests that ABPA might be underdiagnosed. With regard to pharmacotherapy, oral steroids were recommended for 97.1% of patients and oral steroids plus inhaled corticosteroids plus antifungal agent were used with 41.2% of patients. The armamentarium for treatment of ABPA includes oral corticosteroids as the initial treatment with inhaled corticosteroids used for management of persistent asthma. Azoles remain adjunctive. Published experience with omalizumab has been limited. (C) 2014 American Academy of Allergy, Asthma & Immunology
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