A 12-year longitudinal study of Aspergillus sensitivity in patients with cystic fibrosis.
OBJECTIVE
The object of the study was to longitudinally follow immune parameters of Aspergillus fumigatus sensitization so as to predict those at risk for developing allergic bronchopulmonary aspergillosis (ABPA).


METHODS
Patients were evaluated for 5 immune parameters (skin test [ST], positive precipitating antibody [PPN], total IgE, IgE anti-A fumigatus antibody [IgE-Af], and IgG anti-A fumigatus antibody [IgG-Af]) at yearly intervals over a 12-year time period.


METHODS
Patients were enrolled and evaluated during routine visits to the cystic fibrosis (CF) clinic at Cardinal Glennon Children's Hospital, St. Louis.


METHODS
One hundred eighteen patients with documented CF participated.


METHODS
None.


RESULTS
Six patients were diagnosed as having ABPA. In the non-ABPA patient group, 42% had a positive ST, 42% were PPN positive, 54% had IgE-Af, 61% had IgG-Af, and 10% had an IgE greater than 1,000 IU/mL at some point in time. However, on follow-up, 18% lost skin reactivity, 54% lost-PPN, 53% lost IgE-Af, 45% lost IgG-Af, and IgE greater than 1,000 IU/mL declined more than 72% in 64% of patients. These losses were spontaneous, without systemic corticosteroid intervention.


CONCLUSIONS
Spontaneous diminution and loss of immune parameters in non-ABPA CF patients prevented us from defining a profile of sensitivity likely to result in ABPA. This variability highlights the importance of obtaining follow-up studies and including clinical symptoms when considering the diagnosis of ABPA in patients with CF.
Hutcheson
P S
PS
Department of Internal Medicine, St. Louis University Health Sciences Center, USA.
Knutsen
A P
AP
Rejent
A J
AJ
Slavin
R G
RG
D000293:Adolescent; D000328:Adult; D000908:Antibodies, Fungal / Q000032:analysis; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000175:diagnosis; D001232:Aspergillus fumigatus / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications / Q000276:immunology*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis*; D007073:Immunoglobulin E / Q000032:analysis; D007074:Immunoglobulin G / Q000032:analysis; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012882:Skin Tests
D000908:Antibodies, Fungal; D007074:Immunoglobulin G; D007073:Immunoglobulin E