Factors effecting impact of Aspergillus fumigatus sensitization in cystic fibrosis

Abstract

The clinical impact of Aspergillus fumigatus (Af) sensitization in cystic fibrosis (CF) is controversial. We examined the effect of Af sensitization (Afs) on pulmonary function and growth using a retrospective cohort analysis over two 5-year study periods: 1996-2000 (19 Afs cases and 19 controls) and 2001-2005 (24 Afs cases and 23 controls). Sensitization was defined as Af specific radioallergosorbent test (RAST) >or= 17.5 iu/ml and total serum IgE level >or=150 iu/ml. We examined the impact of changing treatment schedules over these periods. Afs cases had lower median FEV(1) %predicted (%PR) compared to matched controls 1996: 67 versus 80, P < 0.01; 2001: 78 versus 93, P < 0.01. Afs cases in the 2001 cohort had a higher FEV(1) %PR compared to Afs cases in the 1996 cohort: 78 versus 67, P < 0.01. For the 1996 Afs cohort FEV(1) %PR fell significantly over 5 years but not for the 2001 Afs cohort. Af RAST and total IgE reflected the changes in pulmonary function. Children in the 2001 Afs cohort were prescribed significantly more oral antifungal treatment (odds ratio 4.3, 95%CI 1.2-15.7, P = 0.03). Afs children continue to have poorer lung function compared to controls but this observational, hypothesis generating study, suggests that the use of antifungal treatment is associated with better lung function.

Prevalence of Aspergillus sensitization and allergic bronchopulmonary aspergillosis in cystic fibrosis: systematic review and meta‐analysis

“…This is in contrast to the results of an earlier meta-analysis in asthma, where intradermal tests were found to be more sensitive than skin prick tests [4]. The clinical significance of Aspergillus sensitization in patients with CF is well established, and several reports suggest that CF patients with AS have poorer lung function and a greater decline in lung function as compared to those without [27,37,51,64,65,88,89].…”

Allergic bronchopulmonary aspergillosis and Aspergillus infection in cystic fibrosis

“…fungal asthma), as suggested by studies associating A. fumigatus sensitization with worse lung function in CF [18,[21][22][23]. This comports with recent studies of severe asthma in which fungal sensitization (particularly to A. fumigatus) is a prominent finding and antifungals appear clinically beneficial [24,25 ,26-28].…”

“…A UK study of CF patients sensitized to A. fumigatus (not limited to ABPA) from 1996 to 2006 showed improved lung function when antifungal therapy was employed [18]. Recently, Amin et al [19 ] retrospectively examined the effect of A. fumigatus infection on lung function and hospitalization for pulmonary exacerbation in 230 pediatric patients followed from 1999 to 2006.…”

Blood basophil activation is a reliable biomarker of allergic bronchopulmonary aspergillosis in cystic fibrosis

“…This distinction is further complicated by a paucity of distinguishing pathogen-specific symptoms and signs [1]. Allergic sensitisation to the filamentous fungus Aspergillus fumigatus significantly impacts the development and severity of CF lung disease [2][3][4][5][6][7][8][9]. Allergic bronchopulmonary aspergillosis (ABPA) is the most common form of allergic bronchopulmonary mycosis [1,10].…”