Aspergillus allergy and allergic bronchopulmonary aspergillosis in cystic fibrosis

Abstract

We have found allergic bronchopulmonary aspergillosis in 8.6% of 105 children with cystic fibrosis (CF). Its development was significantly associated with colonisation of the respiratory tract by Pseudomonas aeroginosa but not necessarily by the use of nebulised antibiotics. At the same time, 30% of the 105 CF children had A. fumigatus growing in their sputum, 30% had positive prick skin tests to A. fumigatus, 23% had a positive IgE antibody to A. fumigatus and 19% positive A. fumigatus precipitins (IgG antibodies). All of these features were significantly associated with the use of nebulised antibiotics but more strongly associated with Pseudomonas colonisation. It is possible that the Pseudomonas facilitates sensitisation to A. fumigatus or, alternatively, that A. fumigatus facilitates colonisation by Pseudomonas. Both hypotheses require investigation.

Cystic fibrosis, atopy, asthma and ABPA

“…50,51 Indeed, it is quite common to be able to culture Aspergillus fumigatus and observe hyphal networks in the sputum of CF patients, with up to 30% having positive cultures. 52 The sensitisation process occurs in genetically susceptible individuals and requires allergen processing by antigen presenting cells, which then stimulate T cells within the bronchoalveolar lymphoid tissue (BALT) in a Th2 balanced way.…”

Skin Test Reactivity to Recombinant <i>Aspergillus fumigatus</i> Allergen l/a in Patients with Cystic Fibrosis

“…weal > 3 mm in diameter) [17], (5) increased total IgE levels (i.e. IgE more than 2 SD greater than normal values for age) [18], (6) increased specific IgE to A. fumigatus (RAST score > 2 ), (7) increased level of specific IgG to A. fumigatus (ELISA > 4 0 EU/ml) [14,19], (2) Aspergillus-aWexgic CF patients: CF patients were assigned to the group with Aspergillus allergy if routine skin prick tests with a commercial allergen preparation (Bencard, Smithkline Beecham, Neuss, Germany) were positive for A. fumigatus (weal S 3 mm in di ameter) [17] or the RAST to A. fumigatus was >2.…”

“…The differentiation between ABPA and allergy to A. fumigatus is difficult but clinically relevant, since untreated ABPA may lead to substantial lung damage including proximal bronchiectasis or total lung collapse [3,4], The importance of IgE and IgG antibodies to A. fum i gatus has been emphasized in ABPA [5], but both antibody classes can also be detected in 20-30% of A.-fumigatus-a\-lergic patients suffering from CF [2]. The reliability of di agnostic procedures such as skin tests depends mostly on This study was partly supported by the Swiss National Foundation Grant No.…”

“…Allergy to Aspergillus fumigatus has been reported in up to 59% of patients with cystic fibrosis (CF) [1], while only few patients develop allergic bronchopulmonary aspergil losis (ABPA) [2]. The differentiation between ABPA and allergy to A. fumigatus is difficult but clinically relevant, since untreated ABPA may lead to substantial lung damage including proximal bronchiectasis or total lung collapse [3,4], The importance of IgE and IgG antibodies to A. fum i gatus has been emphasized in ABPA [5], but both antibody classes can also be detected in 20-30% of A.-fumigatus-a\-lergic patients suffering from CF [2].…”

IL-10 Controls Aspergillus fumigatus- and Pseudomonas aeruginosa-Specific T-Cell Response in Cystic Fibrosis

“…Aspergillus fumigatus is a ubiquitous mold found in up to 50% of CF respiratory secretions (2). The interaction between A. fumigatus and the host organism ranges from simple colonization to allergic bronchopulmonary aspergillosis (ABPA), which may rarely lead to invasive aspergillosis in immune-compromised individuals (3). Characterization, cloning, and production of some recombinant allergens from A. fumigatus improved the diagnostic possibilities (4 -7).…”