a. Fungal sensitization: anti-fungal specific IgE
Sensitization is defined as detectable specific IgE using either skin
prick tests or laboratory methods. According to current literature, the
diagnosis of ABPA is possible when the level of specific IgE
anti-A . fumigatus is greater than 0.35 kUA/L and probable
when the value is equal to or greater than 20 kUA/L (87) (110) (103)
(104).
Quantitative laboratory IgE methods allow dynamic monitoring and
cross-reactivity assessment. Given the variations in fungal extract
preparation and inter-method variability (Figure 3) , dynamic
monitoring must rely on the same method.
Identifying the primary fungal sensitizer is an essential step because
of the extensive cross-reactivity among whole fungal extracts for skin
and IgE tests. It relies on the availability of molecular allergens for
in vitro diagnostics, which is currently limited to Aspergillus
fumigatus, A. alternata, C. herbarum , and Malassezia
sympodialis .