Allergic bronchopulmonary aspergillosis in cystic fibrosis

To the Editor: The main criticism arising from Kastelik et al . 1 on the study of allergic bronchopulmonary aspergillosis (ABPA) based on the data of the European Registry of Cystic Fibrosis (ERCF) 2 regards the criteria adopted for the ABPA diagnosis: positive markers of hypersensitivity to Aspergillus fumigatus plus a physician's suspicion that the patient has ABPA. We agree that the clinical suspicion is subject to some diagnostic inaccuracy. However, the ERCF required that the clinical suspicion was based to some extent on “reversible bronchoconstriction, pulmonary infiltrations, elevated serum immunoglobulin (Ig)-E and/or IgG specific for A. fumigatus , peripheral eosinophilia (>1000 mL−1), recovery of A. fumigatus from sputum or hyphae present on smear, and response to steroids”. The true problem for the ABPA diagnosis in cystic fibrosis (CF) is that …