Which condition should be evaluated in patients with worsening asthma symptoms and increased IgE and eosinophils?

The condition that should be evaluated in patients with worsening asthma symptoms alongside increased IgE and eosinophils is allergic bronchopulmonary aspergillosis (ABPA). In ABPA, there is a hypersensitivity reaction to the fungus Aspergillus species, which can lead to an exaggerated immune response characterized by elevated levels of specific IgE and eosinophils.

These biomarkers are particularly relevant as they indicate an allergic response that is not just due to asthma exacerbation or other conditions. The presence of eosinophilia and high IgE levels often signifies that a fungal component may be contributing to the patient's respiratory symptoms, necessitating further evaluation for ABPA, especially in individuals with a history of asthma or cystic fibrosis where this condition is more prevalent.

In the context of asthma exacerbation, while increased eosinophils and IgE can occur, these findings alone do not specifically point to an exacerbation without considering other clinical symptoms and the broader context of asthma management. Chronic bronchitis and interstitial lung disease, on the other hand, would typically manifest with different clinical features and do not directly correlate with the specific immune response associated with ABPA. Therefore, when these symptoms and laboratory findings are present, ABPA is a strong