Allergic Bronchopulmonary Aspergillosis (ABPA) Profile I

CPT: 82785; 86003; 86606
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Test Includes

Immunoglobulin E, Total; Aspergillus fumigatus Antibody, IgE; Aspergillus fumigatus Antibody, IgG



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Specimen Requirements


Specimen

Serum


Volume

2 mL


Minimum Volume

1 mL (Note: This volume does not allow for repeat testing.)


Container

Gel-barrier tube


Collection

Transfer separated serum to a plastic transport tube.


Storage Instructions

Room temperature


Stability Requirements

See individual test information.


Causes for Rejection

See individual test information.


Test Details


Use

This profile serves as an aid in the diagnosis of allergic bronchopulmonary aspergillosis (ABPA).


Limitations

Non-fumigatus strains account for ABPA in some cases,1-8 and IgG to these strains may not be detected by the ImmunoCAP® A. fumigatus IgG assay. Labcorp's Aspergillus Precipitating Antibodies, IgG [606846] assay includes most species associated with Aspergillus-related lung disease in the United States.


Methodology

See individual test information.


Additional Information

Aspergillus species are ubiquitous environmental molds that grow on organic matter and aerosolizeconidia.9-11 Humans inhale hundreds of conidia per day without adverse consequences, except for a small minority of people for whom infection with Aspergillus causes significant morbidity. The clinical manifestations of aspergillosis are determined by the host immune response to exposure with the spectrum ranging from a simple allergic response to local lung disease with mycelial balls to catastrophic systemic Aspergillus infection.9,11

Aspergillus is a genus of molds that includes several hundred species that grow in nutrient-depleted environments.9,11 These obligate aerobes are ubiquitous and can be found in virtually every oxygen-rich setting. Aspergillus molds are saprophytes that thrive on decaying organic matter. They are often found as contaminants of starchy foods and other carbon-rich substrates. They are commonly found in soil and marine habitats as well as indoor environments and in drinking water.10 Of the hundred species identified, only a few have been associated with pathology in humans.10-12 Aspergillus fumigatus is the species most commonly associated with disease.13,14

Aspergillus molds continuously disseminate spores (conidia) into the environment.10 Humans are constantly exposed to airborne Aspergillus spores, which, once inhaled, can access the most distal airways of the lungs due to their size and durability.8 In immuno-competent individuals with healthy lungs, inhaled conidia are eliminated by the neutrophils and macrophages of the innate immune system and do not lead to disease.10,15 Illness only develops in a small proportion of patients with altered immune systems or underlying lung pathology.9,11,16,17 Non-invasive forms of Aspergillus-induced lung disease include Allergic Bronchopulmonary Aspergillosis (ABPA)18-20 and Chronic Pulmonary Aspergillosis (CPA).21 In severely immunocompromised individuals, Aspergillus infection of the respiratory system can spread to other organs in a condition referred to as Invasive Pulmonary Aspergillosis (IPA).10,11,15 Antibody testing is central to diagnosis of these conditions, with raised Aspergillus-specific IgG often seen in patients with ABPA and CPA.22 Antibody levels are also used to monitor treatment response in these syndromes.20

Allergic Bronchopulmonary Aspergillosis (ABPA)

ABPA is a relatively uncommon allergic reaction to Aspergilli that almost exclusively affects individuals with asthma or cystic fibrosis.23,24 ABPA typically causes bronchospasm and mucus buildup resulting in coughing, breathing difficulty and airway obstruction. Bronchiectasis can develop, resulting in worsening lung function and increased risk of infection. ABPA in patients with poorly controlled asthma has also been referred to as Severe Asthma with Fungal Sensitization (SAFS).25

The diagnostic criteria for ABPA include the presence of a predisposing condition (asthma or cystic fibrosis) and positive allergen specific IgE to aspergillus species, a total IgE >1000 IU/mL and blood eosinophil count >500 cells/L (in corticosteroid naïve patients).26-28 An elevated serum aspergillus IgG also supports the diagnosis of ABPA.6,22,29-30


Footnotes

1. Barac A, Kosmidis C, Alastruey-Izquierdo A, Salzer HJF, CPAnet. Chronic pulmonary aspergillosis update: A year in review. Med Mycol. 2019 Apr 1;57(Supplement_2):S104-S109.30816975
2. Perfect JR, Cox GM, Lee JY, et al. The impact of culture isolation of Aspergillus species: a hospital-based survey of aspergillosis. Clin Infect Dis. 2001 Dec 1;33(11):1824-1833.11692293
3. Steinbach WJ, Marr KA, Anaissie EJ, et al. Clinical epidemiology of 960 patients with invasive aspergillosis from the PATH Alliance registry. J Infect. 2012 Nov;65(5):453-464.22898389
4. Enoch DA, Ludlam HA, Brown NM. Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol. 2006 Jul;55(Pt 7):809-818.16772406
5. Gupta K, Gupta P, Mathew JL, et al. Fatal Disseminated Aspergillus penicillioides Infection in a 3-Month-Old Infant with Suspected Cystic Fibrosis: Autopsy Case Report with Review of Literature. Pediatr Dev Pathol. Nov/Dec 2016;19(6):506-511.26579953
6. Balajee SA, Kano R, Baddley JW, et al. Molecular identification of Aspergillus species collected for the Transplant-Associated Infection Surveillance Network. J Clin Microbiol. 2009 Oct;47(10):3138-3141.19675215
7. Lass-Flörl C, Griff K, Mayr A, et al. Epidemiology and outcome of infections due to Aspergillus terreus: 10-year single centre experience. Br J Haematol. 2005 Oct;131(2):201-207.16197450
8. Yii AC, Koh MS, Lapperre TS, Tan GL, Chotirmall SH. The emergence of Aspergillus species in chronic respiratory disease. Front Biosci (Schol Ed). 2017 Jan 1;9:127-138.27814579
9. Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011 Sep 1;20(121):156-174.21881144
10. Paulussen C, Hallsworth JE, Álvarez-Pérez S, et al. Ecology of aspergillosis: insights into the pathogenic potency of Aspergillus fumigatus and some other Aspergillus species. Microb Biotechnol. 2017 Mar;10(2):296-322.27273822
11. Mousavi B, Hedayati MT, Hedayati N, Ilkit M, Syedmousavi S. Aspergillus species in indoor environments and their possible occupational and public health hazards. Curr Med Mycol. 2016 Mar;2(1):36-42.28681011
12. Sugui JA, Kwon-Chung KJ, Juvvadi PR, Latgé JP, Steinbach WJ. Aspergillus fumigatus and related species. Cold Spring Harb Perspect Med. 2014 Nov 6;5(2):a019786.25377144
13. Warris A. The biology of pulmonary aspergillus infections. J Infect. 2014 Nov;69 Suppl 1:S36-41.25135079
14. Fang W, Latgé JP. Microbe Profile: Aspergillus fumigatus: a saprotrophic and opportunistic fungal pathogen. Microbiology (Reading). 2018 Aug;164(8):1009-1011.30066670
15. Kanj A, Abdallah N, Soubani AO. The spectrum of pulmonary aspergillosis. Respir Med. 2018 Aug;141:121-131.30053957
16. Sehgal IS, Choudhary H, Dhooria S, et al. Diagnostic cut-off of Aspergillus fumigatus-specific IgG in the diagnosis of chronic pulmonary aspergillosis. Mycoses. 2018 Oct;61(10):770-776.29920796
17. Ullmann AJ, Aguado JM, Arikan-Akdagli S, et al. Diagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline. Clin Microbiol Infect. 2018 May;24 Suppl 1:e1-e38.29544767
18. Greenberger PA, Patterson R. Allergic bronchopulmonary aspergillosis and the evaluation of the patient with asthma. J Allergy Clin Immunol. 1988 Apr;81(4):646-650.3356845
19. Hogan C, Denning DW. Allergic bronchopulmonary aspergillosis and related allergic syndromes. Semin Respir Crit Care Med. 2011 Dec;32(6):682-692.22167396
20. Agarwal R, Aggarwal AN, Sehgal IS, Dhooria S, Behera D, Chakrabarti A. Utility of IgE (total and Aspergillus fumigatus specific) in monitoring for response and exacerbations in allergic bronchopulmonary aspergillosis. Mycoses. 2016 Jan;59(1):1-6.26575791
21. Kosmidis C, Denning DW. The clinical spectrum of pulmonary aspergillosis. Thorax. 2015 Mar;70(3):270-277.25354514
22. Barton RC, Hobson RP, Denton M, et al. Serologic diagnosis of allergic bronchopulmonary aspergillosis in patients with cystic fibrosis through the detection of immunoglobulin G to Aspergillus fumigatus. Diagn Microbiol Infect Dis. 2008 Nov;62(3):287-291.18947811
23. Baxter CG, Denning DW, Jones AM, Todd A, Moore CB, Richardson MD. Performance of two Aspergillus IgG EIA assays compared with the precipitin test in chronic and allergic aspergillosis. Clin Microbiol Infect. 2013 Apr;19:e197-204.23331929
24. Shah A, Panjabi C. Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity. Allergy Asthma Immunol Res. 2016 Jul;8(4):282-297.27126721
25. Greenberger PA. When to suspect and work up allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol. 2013 Jul;111(1):1-4.23806451
26. Agarwal R, Chakrabarti A, Shah A, et al. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy. 2013 Aug;43(8):850-873.23889240
27. Dhooria S, Agarwal R. Diagnosis of allergic bronchopulmonary aspergillosis: a case-based approach. Future Microbiol. 2014;9(10):1195-1208.25405888
28. Agarwal R, Aggarwal AN, Gupta D, Jindal SK. Aspergillus hypersensitivity and allergic bronchopulmonary aspergillosis in patients with bronchial asthma: systematic review and meta-analysis. Int J Tuberc Lung Dis. 2009;13(8):936-944.19723372
29. Balajee SA, Houbraken J, Verweij PE, et al. Aspergillus species identification in the clinical setting. Stud Mycol. 2007;59:39-46.18490954
30. Boyle T, Jang HS, Fulton RB, King G, Fernando SL. The fluorescence enzyme immunoassay has greater utility than the gel precipitin test for the detection of specific IgG antibodies to Aspergillus fumigatus in the diagnosis of allergic bronchopulmonary aspergillosis. Pathology. 2020 Jun;52(4):497-499.32317173

References

Knutsen AP, Bush RK, Demain JG, et al. Fungi and allergic lower respiratory tract diseases. J Allergy Clin Immunol. 2012 Feb;129(2):280-291; quiz 292-293.22284927
Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines ofthe Infectious Diseases Society of America. Clin Infect Dis. 2008 Feb 1;46:327-360.18177225

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
607660 ABPA Profile I Pending 602444 Class Description N/A
607660 ABPA Profile I Pending 002173 Immunoglobulin E, Total IU/mL 19113-0
607660 ABPA Profile I Pending 602471 M003-IgE Aspergillus fumigatus kU/L 6025-1
607660 ABPA Profile I Pending 607590 Aspergillus fumigatus IgG mg/L 26954-8

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