0
Correspondence |

Specific IgE Is Better Than Skin Testing for Detecting Aspergillus Sensitization and Allergic Bronchopulmonary Aspergillosis in AsthmaTest for Allergic Bronchopulmonary Aspergillosis FREE TO VIEW

Inderpaul Singh Sehgal, MD, DM; Ritesh Agarwal, MD, DM, FCCP
Author and Funding Information

From the Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research.

CORRESPONDENCE TO: Ritesh Agarwal, MD, DM, FCCP, Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh-160012, India; e-mail: agarwal.ritesh@live.com


FINANCIAL/NONFINANCIAL DISCLOSURES: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(5):e194. doi:10.1378/chest.15-0069
Text Size: A A A
Published online
To the Editor:

We read with interest the review by Schulman et al1 in a recent issue of CHEST (January 2015) wherein the authors suggest the use of a skin test for screening sensitization to various allergens in preference to specific IgE antibody testing in patients with asthma. We agree with the authors that all patients with asthma should be screened for allergic sensitization against a particular allergen depending on its prevalence. However, we do not agree with the authors’ recommendation that skin testing is the preferred approach as this can potentially miss allergic sensitization against Aspergillus fumigatus. In a study comparing the performance of a skin test (intradermal) or specific IgE (against A fumigatus) for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in 372 subjects with asthma, the sensitivity of an A fumigatus-specific IgE and Aspergillus skin test was 100% and 88% to 95%, respectively, in various models of latent class analysis.2 Thus, if a skin test is used as a screening modality, one can potentially miss 5% to 12% cases of ABPA.

It is extremely important that Aspergillus sensitization or ABPA is not missed. Aspergillus sensitization is associated with poorer lung function and worse symptoms,3 risk of death from asthma,4 and acute attacks of asthma requiring ICU admission5; treatment with itraconazole can potentially improve the quality of life in these patients.6 Furthermore, the prevalence of ABPA in Aspergillus sensitization is about 40%,7 and delay in diagnosis and treatment of ABPA can cause irreversible lung damage in the form of bronchiectasis, lung fibrosis, and, finally, end-stage lung disease and respiratory failure.8

References

Schulman ES, Pohlig C. Rationale for specific allergen testing of patients with asthma in the clinical pulmonary office setting. Chest. 2015;147(1):251-258. [CrossRef] [PubMed]
 
Agarwal R, Maskey D, Aggarwal AN, et al. Diagnostic performance of various tests and criteria employed in allergic bronchopulmonary aspergillosis: a latent class analysis. PLoS ONE. 2013;8(4):e61105. [CrossRef] [PubMed]
 
Agarwal R, Noel V, Aggarwal AN, Gupta D, Chakrabarti A. Clinical significance ofAspergillussensitisation in bronchial asthma. Mycoses. 2011;54(5):e531-e538. [CrossRef] [PubMed]
 
Targonski PV, Persky VW, Ramekrishnan V. Effect of environmental molds on risk of death from asthma during the pollen season. J Allergy Clin Immunol. 1995;95(5 pt 1):955-961. [CrossRef] [PubMed]
 
Black PN, Udy AA, Brodie SM. Sensitivity to fungal allergens is a risk factor for life-threatening asthma. Allergy. 2000;55(5):501-504. [CrossRef] [PubMed]
 
Denning DW, O’Driscoll BR, Powell G, et al. Randomized controlled trial of oral antifungal treatment for severe asthma with fungal sensitization: The Fungal Asthma Sensitization Trial (FAST) study. Am J Respir Crit Care Med. 2009;179(1):11-18. [CrossRef] [PubMed]
 
Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Aspergillushypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma: systematic review and meta-analysis. Int J Tuberc Lung Dis. 2009;13(8):936-944. [PubMed]
 
Agarwal R, Chakrabarti A, Shah A, et al; ABPA Complicating Asthma ISHAM Working Group. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013;43(8):850-873. [CrossRef] [PubMed]
 

Figures

Tables

References

Schulman ES, Pohlig C. Rationale for specific allergen testing of patients with asthma in the clinical pulmonary office setting. Chest. 2015;147(1):251-258. [CrossRef] [PubMed]
 
Agarwal R, Maskey D, Aggarwal AN, et al. Diagnostic performance of various tests and criteria employed in allergic bronchopulmonary aspergillosis: a latent class analysis. PLoS ONE. 2013;8(4):e61105. [CrossRef] [PubMed]
 
Agarwal R, Noel V, Aggarwal AN, Gupta D, Chakrabarti A. Clinical significance ofAspergillussensitisation in bronchial asthma. Mycoses. 2011;54(5):e531-e538. [CrossRef] [PubMed]
 
Targonski PV, Persky VW, Ramekrishnan V. Effect of environmental molds on risk of death from asthma during the pollen season. J Allergy Clin Immunol. 1995;95(5 pt 1):955-961. [CrossRef] [PubMed]
 
Black PN, Udy AA, Brodie SM. Sensitivity to fungal allergens is a risk factor for life-threatening asthma. Allergy. 2000;55(5):501-504. [CrossRef] [PubMed]
 
Denning DW, O’Driscoll BR, Powell G, et al. Randomized controlled trial of oral antifungal treatment for severe asthma with fungal sensitization: The Fungal Asthma Sensitization Trial (FAST) study. Am J Respir Crit Care Med. 2009;179(1):11-18. [CrossRef] [PubMed]
 
Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Aspergillushypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma: systematic review and meta-analysis. Int J Tuberc Lung Dis. 2009;13(8):936-944. [PubMed]
 
Agarwal R, Chakrabarti A, Shah A, et al; ABPA Complicating Asthma ISHAM Working Group. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013;43(8):850-873. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543