{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:55:55Z","timestamp":1789646155062,"version":"4.0.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001411","name":"Indian Council of Medical Research","doi-asserted-by":"publisher","award":["5\/8\/4\u20103\/COPD\/2019\u2010NCD\u2010I"],"award-info":[{"award-number":["5\/8\/4\u20103\/COPD\/2019\u2010NCD\u2010I"]}],"id":[{"id":"10.13039\/501100001411","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100016724","name":"Postgraduate Institute of Medical Education and Research, Chandigarh","doi-asserted-by":"publisher","award":["32762\u2010318"],"award-info":[{"award-number":["32762\u2010318"]}],"id":[{"id":"10.13039\/100016724","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Experimental Allergy"],"published-print":{"date-parts":[[2026,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n \n Allergic bronchopulmonary aspergillosis (ABPA) requires screening in adults with asthma using\n \n Aspergillus fumigatus<\/jats:italic>\n <\/jats:styled-content>\n \u2010specific IgE (Af\u2010IgE). The current Af\u2010IgE threshold of 0.35\u2009kUA\/L has low specificity, leading to unnecessary downstream testing.\n <\/jats:p>\n <\/jats:sec>\n \n Objectives<\/jats:title>\n To determine an optimal Af\u2010IgE threshold that maintains high sensitivity while improving specificity for ABPA screening in adults with asthma.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We performed a diagnostic accuracy study of prospectively collected data using distinct derivation and validation cohorts in a tertiary care setting. The index test was ImmunoCAP Af\u2010IgE at thresholds of 0.35, 0.70 and 0.90 kUA\/L. The reference standard was the 2024 ISHAM\u2010ABPA criteria applied by investigators aware of all test results.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n We included 543 consecutive asthmatic subjects investigated for possible ABPA in the derivation cohort (July 2017\u2013September 2018) and 375 subjects with established asthma and ABPA in the validation dataset (January 2020\u2013December 2023). ABPA prevalence was 19.5% (106\/543) in derivation and 69.6% (261\/375) in validation cohorts. Bayesian latent class analysis estimated a 0.3\u2009kUA\/L cut\u2010off but did not improve specificity; frequentist analysis showed model misfit. In the validation cohort, increasing the threshold from 0.35 to 0.70 kUA\/L improved specificity from 66.7% (95% CI, 57.6\u201374.7) to 72.8% (95% CI, 64.0\u201380.1;\n p<\/jats:italic>\n \u2009=\u20090.016) without significant sensitivity reduction (100% to 98.9%; 95% CI, 96.7\u201399.6;\n p<\/jats:italic>\n \u2009=\u20090.25). No patients with bronchiectasis were missed. At 0.90 kUA\/L, sensitivity significantly decreased (97.7%; 95% CI, 95.1\u201398.9;\n p<\/jats:italic>\n \u2009=\u20090.031).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n ImmunoCAP Af\u2010IgE threshold of 0.70\u2009kUA\/L optimised diagnostic performance for ABPA screening in adults with asthma, potentially reducing unnecessary confirmatory testing.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/cea.70148","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T07:01:46Z","timestamp":1758870106000},"page":"61-67","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Optimal\n \n ImmunoCAP\n Aspergillus fumigatus<\/i>\n <\/scp>\n \u2010Specific\n IgE<\/scp>\n Threshold for Detecting Allergic Bronchopulmonary Aspergillosis in Adults With Asthma: A Diagnostic Accuracy Study"],"prefix":"10.1111","volume":"56","author":[{"given":"Ritesh","family":"Agarwal","sequence":"first","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1111-1008","authenticated-orcid":false,"given":"Puneet","family":"Saxena","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valliappan","family":"Muthu","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inderpaul Singh","family":"Sehgal","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kuruswamy Thurai","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahajal","family":"Dhooria","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mani","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashutosh N.","family":"Aggarwal","sequence":"additional","affiliation":[{"name":"Department of Pulmonary Medicine Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shivaprakash M.","family":"Rudramurthy","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arunaloke","family":"Chakrabarti","sequence":"additional","affiliation":[{"name":"Doodhadhari Burfani Hospital Haridwar India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,26]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/17476348.2025.2517302"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.12595"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2023.04.009"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/cea.14319"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.13388"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00061-2024"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2024.09.002"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/02770903.2024.2439994"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0061105"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2020.08.043"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-012799"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prevetmed.2017.01.006"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.861866"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/myc.70087"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2025.05.038"},{"key":"e_1_2_9_17_1","unstructured":"Global Initiative for Asthma (GINA) \u201cGlobal Strategy for Asthma Management and Prevention \u201d(2004) https:\/\/ginasthmaorg\/wp\u2010content\/uploads\/2023\/04\/GINA\u2010Main\u2010Report\u20102004\u2010WMSApdf."},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5877(01)00272-0"}],"container-title":["Clinical & Experimental Allergy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cea.70148","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T00:27:31Z","timestamp":1767745651000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cea.70148"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,26]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/cea.70148"],"URL":"https:\/\/doi.org\/10.1111\/cea.70148","archive":["Portico"],"relation":{},"ISSN":["0954-7894","1365-2222"],"issn-type":[{"value":"0954-7894","type":"print"},{"value":"1365-2222","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,26]]},"assertion":[{"value":"2025-07-10","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-12","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}