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ABPA found in 26% of paediatric patients with poorly controlled asthma in India

March 20 2015

Many adults with asthma are sensitised to fungi, especially those with severe asthma. Total IgE level is regarded as a good marker for allergic bronchopulmonary aspergillosis (ABPA) - rising during exacerbations and falling during remissions. However there is little data on ABPA in paediatric patients with asthma.

 In a study from India, published in January 2015 (Singh et al) ABPA was found in 26% of 100 paediatric patients with poorly controlled asthma was examined. ABPA diagnosis was obtained using all the following approved criteria: Aspergillus skin test, pulmonary function, A. fumigatus specific IgE , total IgE and chest X-ray and CT scans. There was  a significant difference in the forced expiratory volume (FEV1) between ABPA positive and negative children, which is consistent with adult ABPA.

Many more boys were affected with ABPA than girls, with a ratio or 4 to 1, compared with those without ABPA in whom the ratio was 3:1. The mean age was 9.6 years with the youngest affected being 5.5 years. Children living in rural areas were more often affected.  Three children (11.5%) had bronchiectasis on CT scan.

In an earlier study in indian children with perennial asthma (1) the prevalence of ABPA was lower at 15%. ABPA also occurs in children with cystic fibrosis, from the age of 4 years.

This study indicates a higher rate of ABPA in paediatric patients with problematic asthma than expected from other studies – but also that a higher cut off value  of total IgE 1200 IU/mL  is proposed as a predictive parameter for ABPA in children with asthma, rather than the 1000 IU/ml used in adults.

The results from this study provoke the question as to whether paediatric patients with poorly controlled asthma should be tested for fungal sensitivity and offered antifungal therapy at an early stage in their management. No antifungal treatment studies have been done in children and there are very few published case reports or series.

Article 

Refs:

1. Chetty A, Bhargava S, Jain RK. Allergic bronchopulmonary aspergillosis in Indian children with bronchial asthma. Ann Allergy 1985; 54: 46–9.