Which are the optimal criteria for the diagnosis of allergic bronchopulmonary aspergillosis? A latent class analysis.

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Which are the optimal criteria for the diagnosis of allergic bronchopulmonary aspergillosis? A latent class analysis.

J Allergy Clin Immunol Pract. 2020 Sep 02;:

Authors: Saxena P, Choudhary H, Muthu V, Sehgal IS, Dhooria S, Prasad KT, Garg M, Saikia B, Aggarwal AN, Chakrabarti A, Agarwal R

Abstract
BACKGROUND: The ideal criteria for diagnosing allergic bronchopulmonary aspergillosis (ABPA) remains unknown because of the lack of a gold standard. Latent class analysis (LCA) using a probabilistic modeling technique can circumvent the need for a reference standard.
OBJECTIVE: To compare the diagnostic performance of various criteria used for evaluating ABPA.
METHODS: We prospectively enrolled consecutive cases of bronchial asthma and performed a series of investigations used for the diagnosis of ABPA. We used LCA to analyze the performance of various existing and novel diagnostic criteria.
RESULTS: Of the 543 subjects (mean age, 37 years; 319 women), 338 (62.2%), and 205 (37.8%) were labeled as ‘mild-to-moderate’ and ‘severe’ asthma, respectively. The subjects with severe asthma had a longer duration of asthma and a higher number of exacerbations in the previous year. The prevalence of Aspergillus fumigatus sensitization was 41% and 30%, using the A.fumigatus-specific IgE and skin test, respectively. The prevalence of ABPA was 16%, using both the Rosenberg-Patterson and the ISHAM-ABPA working group criteria. The ISHAM criteria were slightly more sensitive (99% vs. 98%) and specific (89% versus 81%) than the Patterson criteria. We obtained optimal diagnostic performance by altering the existing ISHAM criteria (serum total IgE >500 IU/mL, excluding the skin test, and using CT thorax instead of chest radiograph).
CONCLUSIONS: The ISHAM-ABPA working group criterion was only marginally better than the Patterson criteria in diagnosing ABPA among asthmatics <66 years of age. The diagnostic performance however improved by modifying the prevailing ISHAM criteria, but with increased cost.

PMID: 32890756 [PubMed – as supplied by publisher]

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