Background The International Society for Human and Animal Mycology (ISHAM) working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) a decade ago. There is a need to update these recommendations due to advances in diagnostics and therapeutics. Methods An international expert group was convened to develop guidelines for managing ABPA (caused by Aspergillus spp.) and allergic bronchopulmonary mycosis (ABPM; caused by fungi other than Aspergillus spp.) in adults and children using a modified Delphi method (two online rounds and one in-person meeting). We defined consensus as ≥70% agreement or disagreement. The terms “recommend” and “suggest” are used when the consensus was ≥70% and <70%, respectively. Results We recommend screening for A. fumigatus sensitisation using fungus-specific IgE in all newly diagnosed asthmatic adults at tertiary care but only difficult-to-treat asthmatic children. We recommend diagnosing ABPA in those with predisposing conditions or compatible clinico-radiological presentation, with a mandatory demonstration of fungal sensitisation and serum total IgE ≥500 IU·mL −1 and two of the following: fungal-specific IgG, peripheral blood eosinophilia or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normal A. fumigatus -IgE. Additionally, diagnosing ABPM requires repeated growth of the causative fungus from sputum. We do not routinely recommend treating asymptomatic ABPA patients. We recommend oral prednisolone or itraconazole monotherapy for treating acute ABPA (newly diagnosed or exacerbation), with prednisolone and itraconazole combination only for treating recurrent ABPA exacerbations. We have devised an objective multidimensional criterion to assess treatment response. Conclusion We have framed consensus guidelines for diagnosing, classifying and treating ABPA/M for patient care and research.

Allergic bronchopulmonary aspergillosis

Clinical Practice

Pulmonary aspergillosis

10.1183/13993003.00061-2024

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Citations (50)

Role of corticosterone in modulation of eicosanoid biosynthesis and antiinflammatory activity by 5-lipoxygenase (5-LO) and cyclooxygenase (CO) inhibitors

Agents and Actions (1991)

L. A. Tomchek David A. Hartman Anne Lewin William J. Calhoun T. T. Chau

Corticosterone

Modulation (music)

10.1007/bf01993226

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Citations (11)

Clinical Burden and Predictors of Asthma Exacerbations in Patients on Guideline-based Steps 4-6 Asthma Therapy in the TENOR Cohort

The Journal of Allergy and Clinical Immunology In Practice (2014)

William J. Calhoun Tmirah Haselkorn David R. Mink Dave P. Miller Alejandro Dorenbaum

Guideline

Asthma Exacerbations

10.1016/j.jaip.2013.11.013

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Citations (51)

The Effect of Salmeterol on Markers of Airway Inflammation Following Segmental Allergen Challenge

American Journal of Respiratory and Critical Care Medicine (2001)

William J. Calhoun KIMBERLEY L. HINTON JENNIFER J. KRATZENBERG

Inflammation is a critical component of asthma. Drugs that control asthma generally reduce the degree of airway inflammation. There is theoretical controversy surrounding the effects of β2-agonists on airway inflammation, with some studies suggesting an anti-inflammatory effect, and others predicting a proinflammatory influence. We conducted a double-blind, placebo-controlled, crossover study of the effect of the long-acting β2-agonist salmeterol on airway inflammation induced by segmental allergen challenge (SAC). We studied 13 allergic asthmatics controlled with as needed inhaled short-acting β2-agonists alone, and used bronchoalveolar lavage 5 min and 48 h after SAC to assess airway inflammation, and the effects of salmeterol on this process. Salmeterol therapy improved FEV1, but had no significant effect on the immediate or late cellular response to SAC. One measure of superoxide production was reduced, and interleukin-4 (IL-4) was reduced in baseline samples, but other indices of airway inflammation were unchanged by salmeterol therapy. We conclude that salmeterol therapy alone does not meaningfully reduce airway inflammation induced by SAC, but equally importantly, does not result in amplified inflammation.

Salmeterol

Proinflammatory cytokine

10.1164/ajrccm.163.4.2001060

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Citations (43)

Strategies for Tailoring Asthma Treatment in Adults—Reply

JAMA (2013)

William J. Calhoun Homer A. Boushey Bill T. Ameredes

10.1001/jama.2012.73385

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P240 Improvement of eosinophilic asthma due to two part paint exposure with mepolizumab