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Table 1 Criteria for diagnosis of fungal allergic airways diseases associated with severe asthma and their complications

From: The role of antifungals in the management of patients with severe asthma

Disease entity Clinical criteria Immunologic Mycologic Complications
Allergic bronchopulmonary aspergillosis (ABPA) 1. Asthma or cystic fibrosisa
2. Fleeting or fixed pulmonary opacities on chest radiograph
3. Peripheral eosinophil count > 500 cells/µL
1. Type I Aspergillus skin test positive (immediate cutaneous hypersensitivity reaction to Af) or elevated IgE levels against A. fumigatus,
2. Elevated total IgE levels more than 1000 IU/mL (unless all other criteria is met, then total IgE levels can be less than 1000 IU/mL)
3. Elevated Aspergillus IgG or precipitating antibodies
None Bronchiectasis
Hyper-attenuated mucous
Asthma exacerbations
ABPA exacerbations
Bronchiectasis exacerbations
Fixed airways obstruction
Chronic pulmonary aspergillosis
Focal pleural based fibrosis areas
Allergic fungal airways disease (AFAD) or Airways Mycosis Asthma with sensitization and/or inflammation and tissue damage including radiological abnormalities and fixed airways obstruction Positive immediate skin test (SPT) and fungal specific IgE Documented (PCR or culture) or presumed Bronchial wall thickening
Bronchiectasis
Fixed airways obstruction
Severe asthma with fungal sensitisation (SAFS) Severe asthma Positive immediate skin test (SPT) and specific IgE to Aspergillus fumigatus, Alternaria alternata, Cladosporium herbarum, Penicillium chrysogenum, Candida albicans, Trichophyton mentagrophytes, or Botrytis cinereal None Asthma exacerbations
Bronchial wall thickening
Fixed airways obstruction
Chronic pulmonary aspergillosis
Aspergillus bronchitis# Non-immunocompromised Major symptoms of cough, breathlessness and sputum production
Bronchiectasis common
May have a raised Aspergillus fumigatus IgG Culture or PCR positive for Aspergillus on at least 2 occasions separated in time (to exclude colonisation)  
  1. These entities are not mutually exclusive
  2. aRare cases are described in patients without either of these conditions. # may also be caused by other fungi including Candida albicans and Scedosporium spp. Reference [5, 6, 84]