REGULAR ARTICLE The diagnostic criteria for allergic bronchopulmonary aspergillosis in children with poorly controlled asthma need to be re-evaluated Meenu Singh (meenusingh4@gmail.com) 1 , Subhamoy Das 1 , Anil Chauhan 1 , Nandini Paul 1 , Kushaljit Singh Sodhi 2 , Joseph Mathew 1 , Arunaloke Chakrabarti 3 1.Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India 2.Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India 3.Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India Keywords Airway inflammation, Allergy, Asthma Correspondence Meenu Singh, MD, Advanced Pediatric Centre, Post Graduate Institute of Medical Education and Research, Sector-12, Chandigarh, India160012. Tel: +91-172-2755306 | Fax: +91-172-2744401 | Email: meenusingh4@gmail.com Received 26 June 2014; accepted 13 January 2015. DOI:10.1111/apa.12930 ABSTRACT Aim: The aim of this study was to examine the association between allergic bronchopulmonary aspergillosis (ABPA) and poorly controlled asthma in children and appraise the diagnostic criteria. Methods: The study included 100 children with poorly controlled asthma. We diagnosed ABPA using the Aspergillus skin test, pulmonary function test, total and specific immunoglobulin E (IgE) to Aspergillus fumigatus, chest radiograph and high-resolution computed tomography. Patients were diagnosed and classified according to the Rosenberg–Patterson criteria for ABPA. The cut-off value for total serum IgE was calculated by receiver operating characteristics curve analysis. Results: Of 100 children with poorly controlled asthma, 26 patients were ABPA positive. There was a significant difference in the forced expiratory volume in 1-sec/forced vital capacity ratio between ABPA positive (0.78  0.14) and negative (0.87  0.15) children (p = 0.008). ABPA positive children were categorised as seropositive, central bronchiectasis and other radiological findings. The receiver operating characteristics curve was constructed, and a value of 1200 IU/mL of total IgE was observed, with 88.5% sensitivity and 70.5% specificity. Conclusion: This study showed an association between ABPA and poorly controlled asthma in children and suggests a higher cut-off value of total IgE for the diagnosis of ABPA. BACKGROUND There is overwhelming evidence for the presence of fungal sensitisation in patients with asthma. A large number of Aspergillus species have been found to be associated with asthma, the most prevalent being Aspergillus fumigatus. This is thought to be the strongest candidate responsible for two extreme immunologic phenomena, Aspergillus- sensitive asthma and allergic bronchopulmonary aspergil- losis (ABPA). ABPA is an inflammatory pulmonary disorder that is characterised by immunological hypersensitivity to the allergens of Aspergillus fumigatus (1). The immuno- globulin E (IgE) level is a marker of immunologic response in ABPA, with a fall in the level representing remission and a rise indicating exacerbation (1). The disorder was first reported in 1890 and was later described by Hinson et al. in 1952 (2). Although Aspergillus fumigatus is most frequently associated with ABPA, Aspergillus flavus, Aspergillus niger, Aspergillus oryzae and Aspergillus glaucis are also respon- sible for ABPA (2). There are few studies on ABPA in children with bronchial asthma, although it could be suspected that poorly controlled asthma might be asso- ciated with fungal sensitisation (3,4). Studies on fungal sensitisation in asthmatics have shown that it is asso- ciated with a reduced postbronchodilator forced expiratory volume (FEV1) (5). There is a lack of consensus on the Abbreviations ABPA, Allergic bronchopulmonary aspergillosis; BMI, Body mass index; FEV1, Forced expiratory volume; FVC, Forced vital capacity; IgE, Immunoglobulin E. Key notes  This study examined the association between allergic bronchopulmonary aspergillosis (ABPA) and poorly controlled asthma.  Just over a quarter (26/100) of the children were ABPA positive with a significant difference in the forced expiratory volume in 1-sec/forced vital capacity ratio between ABPA positive and negative children.  We found an association between ABPA and poorly controlled asthma and suggest a higher cut-off value of total immunoglobulin E for diagnosis. ©2015 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd 1 Acta Pædiatrica ISSN 0803-5253