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ISHAM criteria for ABPA

Application of the ISHAM criteria for diagnosis of ABPA in

Diagnosis of ABPA by ISHAM criteria Stage 2, 4, 5a, or 5b Total serum IgE > 1000 IU/mL No Mab or azole therapy in last 6 months Site Performance and Subject Recruitmen According to the ABPA in CF consensus criteria, serum IgE >500 IU·mL −1 is considered diagnostic . The ISHAM working group has proposed a cut-off level of 1000 IU·mL −1 , as they felt that a cut-off of 500 IU·mL −1 may lead to over diagnosis of ABPA. This value needs global validation as it could possibly be affected by ethnicity. ISHAM criteria for diagnosis of ABPA. Despite the requirement of one predisposing condition, ISHAM notes that a diagnosis of ABPA is still possible in patients without asthma or cystic fibrosis, albeit very rare [ New criteria by the ABPA Complicated Asthma ISHAM Working Group suggests a 6-stage criteria for the diagnosis of ABPA, though this is yet to be formalised into official guidelines. This would replace the current gold standard staging protocol devised by Patterson and colleagues

Allergic bronchopulmonary aspergillosis: review of

The ISHAM group diagnostic criteria for ABPA are summarized in . [1] , [28] First, predisposed asthmatic and CF individuals should first undergo screening for sensitization to A. fumigatus . While skin prick or intradermal testing has been used as the screening tool, its suboptimal sensitivity of approximately 90%, lack of standardization, and. The ISHAM-ABPA working group has proposed new criteria, which were published in 2013. After publication of these criteria, several new pieces of evidence have emerged. For instance, A. fumigatus-specific IgE and IgG are more sensitive than skin testing and serum A. fumigatus precipitins, respectively ,. Moreover, inclusion of bronchiectasis may. Mycology (ISHAM) proposed different diagnos-tic criteria, applicable to both asthmatic and CF patients, in which some criteria are mandatory such as total serum IgE levels >1000 UI/mL (Table 2),7 which exclude some patients, but both criteria are validated and can be used.2,5 Based on these criteria, patients can be classifie ISHAM-ABPA Working Group diagnostic criteria for ABPA (suggested modifications) Predisposing conditions: Asthma, cystic fibrosis: Obligatory criteria (both should be present) A. fumigatus-IgE >0.35 kUA/l: Total IgE >1000 IU/ml: Other criteria (at least 2 out of 3) Peripheral blood eosinophil count >500 cells/µ Allergic bronchopulmonary aspergillosis (ABPA), a lung disease of hypersensitivity to Aspergillus fumigatus ( A. fumigatus) that primarily occurs in people with asthma or with cystic fibrosis, is seen in 2 to 19 percent of people with CF. People with CF may be predisposed to ABPA because of abnormal airway surface liquid and CF mucus

The International Society for Human and Animal Mycology (ISHAM) has constituted a working group on ABPA complicating asthma (www.abpaworkinggroup.org), which convened an international conference to summarize the current state of knowledge, and formulate consensus‐based guidelines for diagnosis and therapy Historical diagnosis for patients with stable ABPA and how may stable ABPA be defined? ISHAM criteria: how best to apply to get a homogenoustrial population without making recruitment unfeasible The diagnosis of ABPA was made on the ISHAM-ABPA working group criteria. High resolution computed tomography (HRCT) and 3 T MRI of the chest was performed on the same day. Bronchiectasis, consolidation, nodules, and mucus impaction were assessed in all segments SELECT INCLUSION CRITERIA. Female and Male patients aged 18-75 years inclusively at the time of Visit 1 with a physician diagnosis of Allergic Bronchopulmonary Aspergillosis has met the ISHAM Working Group Diagnostic Criteria for ABPA: Predisposing condition: Bronchial asthma; Obligatory criteria (both should be present

The diagnostic criteria for ABPA have been revised several times over the past six decades since the malady was first brought to attention. But the diagnostic process is far from perfect,. ISHAM | The International Society for Human & Animal Mycology. ISHAM is a world-wide organization that intends to represent all medical mycologists, clinical scientists and fundamental researchers with interest in fungal diseases

Diagnostic criteria for ABPA by the international society for human and animal mycology (ISHAM) (2013). 7 View larger version The objectives of ABPA management are controlling inflammation, reducing the number of exacerbations and limiting the progression of lung damage In 2013, the ISHAM working group developed their own criteria for ABPA. It was divided into predisposing conditions like asthma or cystic fibrosis. The next section was the obligatory criteria which consisted of two points, both of which need to be present [22] This is the first study to validate ISHAM criteria for ABPA/ABPM diagnosis. Sensitivities of 77.2% for pathological ABPM and 82.7% for physician-diagnosed disease were significantly better than Rosenberg-Patterson criteria, but with slightly lower specificity, especially for cases with severe asthma with Aspergillus sensitization. ISHAM. Criteria proposed by the International Society for Human and Animal Mycology (ISHAM) working group for diagnosis of ABPA: 1. Predisposing asthma or cystic fibrosis. 2. Obligatory criteria . Type I - positive Aspergillus skin test or elevated IgE levels against Aspergillus fumigatus and ; Elevated total IgE levels (value >1000 IU/mL) 3 The ISHAM-ABPA working group has proposed new criteria, which were published in 2013 3. After publication of these criteria, several new pieces of evidence have emerged. For instance, A. fumigatus-specific IgE and IgG are more sensitive than skin testing and serum A. fumigatus precipitins, respectively 6,70. Moreover, inclusion of.

New clinical diagnostic criteria for allergic

  1. These categories were defined as follows: ABPA met all the ISHAM criteria ; AF-S displayed sIgE to Af (0.1 kUA/L or greater) without fulfilling the ISHAM criteria for ABPA; fungal colonization was defined as at least one filamentous fungus cultured from a bronchial sample during the previous 6 months, without fulfilling the ISHAM criteria.
  2. Diagnosis of ABPA is often made using the ISHAM criteria (Table 1) [7]. is patient presented with both ISHAM notes that a diagnosis of ABPA can still be made despite not presenting with these conditionsalthoughthisisrare. ABPA is characterized by mucoid bronchial obstruction
  3. The diagnosis of ABPA was made on the ISHAM-ABPA working group criteria. High resolution computed tomography (HRCT) and 3 T MRI of the chest was performed on the same day. Bronchiectasis, consolidation, nodules, and mucus impaction were assessed in all segments
  4. These criteria were also applied to the 179 cases with physician-diagnosed ABPA/ABPM in a nationwide Japanese survey. Results: The sensitivity for pathological ABPM with Rosenberg-Patterson criteria, ISHAM criteria, and this new criteria were 25.3%, 77.2%, and 96.2%, respectively
  5. The diagnostic criteria for ABPA is outlined in Table 1, as per the latest. International Society for Human & Animal Mycology (ISHAM) criteria. Table 1: Modified ISHAM working group 2013 criteria for diagnosis of ABPA [7] 1. Predisposing asthma or CF 2. Obligatory criteria a. and mortality in immunocompromised patients. It IgE> 1000 IU/mL and b
  6. Although there are many diagnostic criteria for ABPA, Maleki et al. showed that there was no significant differences on the reported rate of ABPA prevelance between the Cystic Fibrosis Foundation and International Society for Human and Animal Mycology (ISHAM) diagnostic criteria . Clinical Finding
  7. The several researches have strived to classify ABPA on radiological basis, among them recently published International Society for Human and Animal Mycology (ISHAM) working group has classified ABPA based on computed tomography (Table 1), manifestations varying from no significant abnormality, to high attenuation mucus to chronic fibrotic.

The composite findings of asthma, blood eosinophilia, elevated total IgE level and central bronchiectasis on HRCT favoured ABPA, but the diagnosis required criteria that was described first by Rosenberg-Patterson in 1978. 7 These have evolved and modified first by Greenberger 1 and recently by the ISHAM. 8 Greenberger's 1 criteria are: (i. However, the ISHAM working group has indicated that, in the special condition of CF, the diagnosis of ABPA cannot rely on the sole standard of immunologic findings (5,13), and the current standard of reference to overcome difficulties remains the criteria of the CFFC

Application of ISHAM guidance on ABPA diagnosis to a

Which are the optimal criteria for the diagnosis of

a more practical criteria in 2013 [9] and Agarwal et al. [10] proposed a revised version based on ISHAM criteria and new scoring system recently. Although the newly proposed criteria will ensure accurate diagnosis, ABPA can remain surprising silent, and this underscores the need for routinely screening the asthmatic patients for ABPA A Case of Allergic Bronchopulmonary Aspergillosis (ABPA) in a Patient with a History of Cocaine Use and Tuberculosis Table 1 ISHAM criteria for diagnosis of ABPA There is a lack of consensus on the minimum criteria, either major or minor, required for the diagnosis of ABPA. To overcome this issue, the International Society for Human and Animal Mycology (ISHAM) established a working group in 2011 The ISHAM working group new clinical staging of ABPA in asthma . Stage 0: includes clinically stable and well-controlled asthmatic subjects who do . not have any clinical features. suggestive of ABPA but are diagnosed as ABPA when routinely investigated as per the criteria. Stage 1 . has been subclassified as: 1a (wit

ABPA complicating asthma ISHAM working group. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin. Exp. Allergy, 43 (2013), pp. 850-87 The diagnostic criteria for ABPA is outlined in Table 2, as per the latest international Society for Human & Animal Mycology (ISHAM) criteria [13,14]. Investigations Chest radiograph: In allergic Broncho pulmonary aspergillosis, parenchymal opacities found in upper lobes usually Human and Animal Mycology (ISHAM) criteria for ABPA [7]. He started a 6-month treatment schedule with itraconazole and oral prednisone (0.5 mg/kg), which was gradually tapered. Over the 6 months, he was unable to decrease prednisone to below 7 mg/d because of worsening of his symptoms. We then Successful Treatment of Allergic Bronchopulmonar We used new diagnostic criteria consisting of 10 components for ABPA/allergic bronchopulmonary mycosis (ABPM) as proposed by Asano et al. in 2020. The sensitivity of these criteria for physician‐diagnosed ABPA/ABPM is 94.4%; in contrast, the sensitivity of the Rosenberg-Patterson and ISHAM criteria is 49.2% and 82.7%, respectively with ABPA in tertiary care center. Methodology: It is an observational study. Patients data with diagnosis of ABPA from AKUH (agha khan university hospital) admitted in 2016 were collected retrospectively. Patients who fulfilled the ISHAM (International Society for Human and Animal Mycology) criteria were included. History

Allergic bronchopulmonary aspergillosis (ABPA - ISHA

We used new diagnostic criteria consisting of 10 components for ABPA/allergic bronchopulmonary mycosis (ABPM) as proposed by Asano et al. [ 1] in 2020. The sensitivity of these criteria for physician‐diagnosed ABPA/ABPM is 94.4%; in contrast, the sensitivity of the Rosenberg-Patterson and ISHAM criteria is 49.2% and 82.7%, respectively [ 1 ] Diagnostic criteria of ABPA11 Although not prospectively validated, we favor the following diagnostic criteria proposed by the International Society for Human and Animal Mycology (ISHAM) working group for ABPA that simplify prior diagnostic schema (Table 2): Stages of ABPA4,13-15 1. acute stage 2. stage of remission 3. stage of exacerbation 4 The International Society for Human & Animal Mycology (ISHAM) Working Group has proposed a more practical criteria in 2013 and Agarwal et al. proposed a revised version based on ISHAM criteria and new scoring system recently. Although the newly proposed criteria will ensure accurate diagnosis, ABPA can remain surprising silent, and this. Thus ABPA/M, defined by a restrictive set of criteria with relatively arbitrary cut-offs, identified a small subset of patients according to a florid T2 immune response to certain fungi, particularly A. fumigatus. 10,11 This term has become indelibly embedded in the literature, although the lack of a clear statistical basis for the criteria has. Is there ABPA? ISHAM Criteria • Predisposing conditions - Bronchial asthma, cystic fibrosis • Obligatory criteria (both should be present) - Immediate hypersensitivity to Aspergillus Ag OR elevated IgE against Aspergillus fumigatus - Elevated total IgE (>1000 IU/mL

ABPA is a Th2- and IgE-mediated hypersensi-tivity response to Aspergillus with high prevalence (8.9%) in the CF population []. The US CF foun7 - dation and the International Society for Human and Animal Mycology (ISHAM) have published diag-nostic criteria for ABPA in CF (Table 1) [8, 9]. In both criteria, diagnosis depends on elevated tota Criteria: SELECT INCLUSION CRITERIA - Female and Male patients aged 18-75 years inclusively at the time of Visit 1 with a physician diagnosis of Allergic Bronchopulmonary Aspergillosis has met the ISHAM Working Group Diagnostic Criteria for ABPA: - Predisposing condition: Bronchial asthma - Obligatory criteria (both should be present) - Type I. ABPA is a Th2- and IgE-mediated hypersensitivity response to Aspergillus with high prevalence (8.9%) in the CF population . The US CF foundation and the International Society for Human and Animal Mycology (ISHAM) have published diagnostic criteria for ABPA in CF (Table 1) [8, 9] The burden of ABPA and SAFS is 0.86-1.52 million (best estimate, 1.38 million) and 0.6-1.06 million (best estimate, 0.96 million) cases respectively while the five year estimated prevalence of CPA is about 24 cases per 100,000. We used three different methods to determine the asthma burden in India. The WHS survey is the most recent (2002.

Clinical Development of Therapeutics for ABPA: Experiences

RATIONALE: The Modified ISHAM (International Society for Human and Animal Mycology) working group 2013 criteria for diagnosis of allergic bronchopulmonary aspergillosis (ABPA) does not specify a cut-off value for specific IgG anti-Aspergillus fumigatus. METHODS: Case notes of 80 patients (all with severe asthma and peripheral blood eosinophilia >500/ul) suspected of ABPA were retrospectively. Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that results from a hypersensitivity reaction to the fungi Aspergillus fumigatus (Af). It presents with pulmonary infiltrates and bronchiectasis. Past research studies on ABPA have led to the conclusion that it is both underdiagnosed and much more prevalent than previously assumed

The patients meeting the current diagnostic criteria of ABPA (RosenbergePatterson or ISHAM working group) can theoretically include patients with ABPM induced by fungi other than the genus Aspergillus because of cross-reactivity to crude fungal allergen extracts probability of ABPA and postulated that if 6 of the 7 criteria are present disease is highly likely and disease is certain if it is a full house. •They also recommended that any patient with allergic asthma and pulmonary infiltrate should be investigated for ABPA

Allergic bronchopulmonary aspergillosis (ABPA) is an immunological pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus, manifesting with poorly controlled asthma, recurrent pulmonary infiltrates and bronchiectasis. There are estimated to be in excess of four million patients affected world-wide. The importance of recognizing ABPA relates to the improvement of patient. » Female and Male patients aged 18-75 years inclusively at the time of Visit 1 with a physician diagnosis of Allergic Bronchopulmonary Aspergillosis has met the ISHAM Working Group Diagnostic Criteria for ABPA

Female and Male patients aged 18-75 years inclusively at the time of Visit 1 with a physician diagnosis of Allergic Bronchopulmonary Aspergillosis has met the ISHAM Working Group Diagnostic Criteria for ABPA: - Predisposing condition: Bronchial asthma - Obligatory criteria (both should be present) - Type I aspergillus skin test positive. According to the 'ABPA in CF' consensus criteria, serum IgE >500 IU/mL is considered diagnostic. 27 The ISHAM Working Group 29 proposed a cutoff level of 1,000 IU/mL as was initially set forth by Rosenberg and Patterson. 46 This was so because the Working Group 29 felt that a cutoff of 500 IU/mL may lead to overdiagnosis of ABPA Diagnostic criteria for CPA according to the European Society of Clinical Microbiology and Infectious Diseases/European Respiratory Society (ESCMID/ERS) guidelines and diagnostic criteria for ABPA according to the International Society for Human & Animal Mycology (ISHAM) guidelines were retrospectively applied to the 28 patients with a. In rare cases, ABPA can be seen in lung transplant recipients or those with bronchiectasis, chronic granulomatous disease, or hyper-IgE syndrome [6]. The International Society for Human and Animal Mycology (ISHAM) provides a proposed set of diagnostic criteria for ABPA (Table 1 ) [ 7 ].These criteria are divided into three groupings.

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Allergic aspergillosis of the respiratory tract European

Two ABPA diagnostic criteria (ISHAM working group criteria (A) (13)and The Cystic Fibrosis . 99. Foundation (CFF) Consensus Conference criteria (B) (14) were applied in this study. Table 1 . 100. shows the detailed criteria. The diagnosis of ABPA was evaluated by a team work consisting of . 101. pulmonologist, allergist-immunologist. the authors deduced that adult patients with ABPA across the globe could potentially exceed 4.8 million. 28 Since there were no consensus-based guidelines on ABPA so far, the International Society for Human and Animal Mycology (ISHAM), in September 2011, constituted a Working Group on ABPA complicating asthma.29 Data on Aspergillus.

Clinical Diagnostic Criteria for Allergic Bronchopulmonary Aspergillosis (ABPA) (International Society for Human and Animal Mycology, ISHAM) (Clin Exp Allergy, 2013) Predisposing Criteria (One Must Be Present chopulmonary aspergillosis (ABPA) as per ISHAM criteria [1]. Alternative etiologies of hydropneumothorax were ruled out by negative sputum and pleural fluid analysis for tubercular, bacterial and fungal cultures. The patient was initiated on inhaled therapy and oral Prednisolone at a dose of 0.5 mg/kg/day for tw Objective: To evaluate the clinical characteristics and outcome of ABPA patient in a tertiary care center of Pakistan. Method: It was an observational study from January to December 2016 at Aga Khan University, Pakistan. Patient's files with a principle diagnosis of ABPA were reviewed and those who fulfill the ISHAM criteria were included Also, there is no clear consensus on the diagnostic criteria for ABPA, and the criteria have been revised on several occasions since the disorder was first recognized. 37, - 40 Recently, the International Society for Human and Animal Mycology (ISHAM) had convened a Working Group on ABPA complicating asthma to resolve some of these controversies

NURS1105 : Nursing Assignment : Pathophysiology of Acute

A Case of Allergic Bronchopulmonary Aspergillosis (ABPA

Allergic bronchopulmonary aspergillosis - Wikipedi

Therefore, we diagnosed her with ABPA according to the criteria established by the International Society for Hu-man Animal Mycology (ISHAM), even though her total IgE. Intern Med 60: 1443-1450, 2021 DOI: 10.2169/internalmedicine.6217-20 1447 Figure 5 Diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) according to the ISHAM Working Group, adapted from Agarwal R et al. . Table 4. Diagnostic criteria for allergic bronchopulmonary aspergillosis (ABPA) according to the ISHAM Working Group, adapted from Agarwal R et al. [ 16 ] 12. Agarwal R, Chakrabarti A, Shah A, Gupta D, Meis JF, Guleria R, Moss R, Denning DW and For the ABPA complicating asthma ISHAM working group. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria Clinical & Experimental Allergy. 2013; (43): 850-73. 13. Greenberger, PA The characteristics of patients with the first ABPA episode (ISHAM Stage-1) were compared to those of patients with ABPA relapse (Stage-3). METHODS: Eleven patients with ABPA, 6 in stage 1 and 5 in stage 3, were diagnosed and treated at our SANI (Severe Asthma Network Italy) center in Turin, from 2016 to 2019 one of the diagnostic criteria for ABPA as proposed by Rosenberg and Patterson,1 Greenberger,2 and the International Society for Human and Animal Mycology (ISHAM) working group.3 The precipitating Abs method has been traditionally performed for the detection of IgG Abs to Af. Its clinical significance has been well

The diagnosis of asthma was according to the latest Global Initiative for Asthma (GINA) guidelines, and the diagnosis of ABPA was based on the criteria of The International Society of Human and Animal Mycology (ISHAM) working group, which contains two obligatory criteria and three additional criteria (Shah & Panjabi, 2016) The diagnosis of ABPA was based on the criteria of the International Society for Human and Animal Mycology (ISHAM) working Group [15]. The diagnosis of asthma was based on clinical his-tory and medical examination, spirometry and FEV1 reversibility≥12% demonstrated at least once in the pre Clinical and immunologic criteria for the diagnosis of allergic bronchopulmonary aspergillosis. Ann Intern Med. 1977; 86(4):405-414. 10.7326/0003-4819-86-4-405 PMID: 848802. Google Scholar; 26. Agarwal R, Chakrabarti A, Shah A et al. ABPA Complicating Asthma ISHAM Working Group (ABPA). The latter scenario is critical to diagnose because ABPA in CF is as-sociated with more severe worsening and lung damage and requires specific therapeutic management (4). Criteria of ABPA in CF have been established during the Cystic Fibrosis Foundation Consensus Conference (CFFC) (5-7). However, the diagnosis of ABPA re

- Has a body mass index of 18.0 to 35.0 kg/m2 (inclusive) at screening. - Has a historical diagnosis of asthma, as per the Global Initiative for Asthma (GINA) 2018 update. - Has a confirmed historical diagnosis of ABPA, as per the Modified International Society for Human and Animal Mycology (ISHAM) working group 2013 criteria 503 Service Unavailable. The website is currently down for maintenance. We expect to be back soon, Thanks for your patienc The ISHAM Working Group has proposed a latest clinical staging of ABPA, which has identified ABPA into seven clinical stages including stage 0 (diagnosed as ABPA but has no signs and symptoms), stage 1 (acute, 1a: with mucoid impaction, 1b: without mucoid impaction), stage 2 (response), stage 3 (exacerbation), stage 4 (remission), stage 5 (5a. New criteria by the ABPA Complicated Asthma ISHAM Working Group suggests a 6-stage criteria for the diagnosis of ABPA, though this is yet to be formalised into official guidelines. [8] This would replace the current gold standard staging protocol devised by Patterson and colleagues. [19 We enrolled 12 patients with ABPA, 23 patients with allergic asthma and 12 healthy controls from the First Affiliated Hospital of Guangzhou Medical University. The diagnosis of ABPA was based on the criteria of the International Society for Human and Animal Mycology (ISHAM) working Group . The diagnosis of asthma was based on clinical history.

INTRODUCTION. Allergic bronchopulmonary aspergillosis (ABPA) is an idiopathic inflammatory disease of the lung, characterized by an allergic inflammatory response to colonization of the airways by Aspergillus fumigatus or other fungi. The entity was first described in 1952 by Hinson et al., and then again in 1967, when Scadding recognized an association between the disease and proximal. The diagnosis of ABPA is currently made on a combination of clinical, radiological and immunological findings using the Patterson criteria. The management of ABPA consists of anti-inflammatory therapy (systemic glucocorticoids) to suppress the immune activity, and use of antifungal agents to attenuate the fungal load in the airways

ABPA complicating asthma ISHAM working group. Allergic bronchopulmonary aspergillosis: review of literature and proposal of new diagnostic and classification criteria. Clin Exp Allergy . 2013;43(8):850-873 2/ The differential diagnosis is broad but potential etiologies include: 1⃣ Does this patient actually have asthma? 2⃣ Infectious (bacterial, fungal, viral) 3⃣ GERD 4⃣ Congestive Heart Failure 5⃣ Vocal Cord Dysfunction @mdlizs @mkashiouris @B_M_Wiese @ptfaddenMD @DxRxEdu - Twitter thread from Jared Dyer, DO @DrJaredDyer - Rattibh Both the CFF Consensus Conference and the International Society for Human and Animal Mycology (ISHAM) have published guidelines for the screening and diagnosis of ABPA in CF patients, as there is a higher incidence of ABPA in this patient population. 43,44 The CFF Consensus Conference proposed the following diagnostic criteria for ABPA in CF

Oral glucocorticoids are currently the treatment of choice for allergic bronchopulmonary aspergillosis (ABPA). They not only suppress the immune hyperfunction but are also anti-inflammatory. Unfortunately, numerous toxicities and adverse effects have been attributed to glucocorticoids related to both the average dose and cumulative duration of use Newly proposed diagnostic criteria for allergic bronchopul- allergic bronchopulmonary aspergillosis (ABPA) complicating asthma monary aspergillosis Sensitivity, n/N (%) Specificity, n/N (%) Predisposing conditions Bronchial asthma, cystic fibrosis Aspergillus Asthma or Obligatory criteria (both should be present) Antigen ABPA sensitization. There are different diagnostic criteria for the diagnosis of Allergic bronchopulmonary aspergillosis (ABPA) in CF patients. In this present study we evaluated the prevalence of ABPA in Iranian CF patients by two more usual diagnostic criteria as ISHAM working criteria (A) and CF Foundation Consensus Conference criteria (B). Methods. Eighty six.