Serum IgE as an important aid in management of allergic bronchopulmonary aspergillosis

Differentiating patients with allergic bronchopulmonary aspergillosis (ABPA) from patients with asthma who have immediate skin reactivity to Aspergillus fumigatus may be difficult when the characteristic clinical and laboratory findings of ABPA are absent. This article describes the response of ABPA patients to corticosteroid therapy. After treatment of the acute stage of the disease with corticosteroid therapy, all ABPA patients had ≥35% reduction of the total serum IgE within 2 mo. In 30 exacerbations of ABPA in 15 patients, there was ≥35% reduction of the total serum IgE in 24 exacerbations within 2 mo. Of the six exacerbations with <35% reduction of total serum IgE, noncompliance to medical therapy was clearly documented in three exacerbations. In one exacerbation with a slowly resolving pulmonary infiltrate, 6 mo of corticosteroid therapy was required before the total IgE decreased 35%. The total serum IgE and its response to corticosteroid therapy is a sensitive marker in ABPA and can be considered an important aid in management of ABPA. Failure to achieve >35% reduction of total serum IgE by 2 mo with the administration of corticosteroid therapy in patients highly suspected of ABPA ehould make one either question the diagnosis of ABPA or consider noncompliance of the patient to medical management with corticosteroids.