title: IgE-mediated immune responses and airway detection of Aspergillus and Candida in adult cystic fibrosis.
abstract: BACKGROUND
  The recovery of Aspergillus and Candida from the respiratory secretions of patients with cystic fibrosis (CF) is common. Their relationship to the development of allergic sensitization and effect on lung function has not been established. Improved techniques to detect these organisms are needed to increase knowledge of these effects.
  
  
  METHODS
  A 2-year prospective observational cohort study was performed. Fifty-five adult patients with CF had sputum monitored for Aspergillus by culture and real-time polymerase chain reaction and Candida by CHROMagar and carbon assimilation profile (API/ID 32C). Skin prick tests and ImmunoCAP IgEs to a panel of common and fungal allergens were performed. Lung function and pulmonary exacerbation rates were monitored over 2 years.
  
  
  RESULTS
  Sixty-nine percent of patient sputum samples showed chronic colonization with Candida and 60% showed colonization with Aspergillus. There was no association between the recovery of either organism and the presence of specific IgE responses. There was no difference in lung function decline for patients with Aspergillus or Candida colonization compared with those without (FEV₁ percent predicted, P = .41 and P = .90, respectively; FVC % predicted, P = .87 and P = .37, respectively). However, there was a significantly greater decline in FEV1 and increase in IV antibiotic days for those sensitized to Aspergillus (FEV₁ decline, P = .03; IV antibiotics days, P = .03).
  
  
  CONCLUSIONS
  Allergic sensitization is not associated with recovery of Candida or Aspergillus from the sputum of patients with CF. Aspergillus but not Candida sensitization is associated with greater lung function decline and pulmonary exacerbations.
authors.affiliation: National Aspergillosis Centre, Manchester, England; Manchester Adult Cystic Fibrosis Unit, Manchester, England; School of Translational Medicine, University of Manchester, Manchester, England. Electronic address: caroline.baxter@manchester.ac.uk.
authors.forename: Caroline G
authors.initials: CG
authors.lastname: Baxter
authors.affiliation: Mycology Reference Laboratory, University Hospital of South Manchester, Manchester, England; School of Translational Medicine, University of Manchester, Manchester, England.
authors.forename: Caroline B
authors.initials: CB
authors.lastname: Moore
authors.affiliation: Manchester Adult Cystic Fibrosis Unit, Manchester, England.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Jones
authors.affiliation: Manchester Adult Cystic Fibrosis Unit, Manchester, England.
authors.forename: A Kevin
authors.initials: AK
authors.lastname: Webb
authors.affiliation: National Aspergillosis Centre, Manchester, England; School of Translational Medicine, University of Manchester, Manchester, England.
authors.forename: David W
authors.initials: DW
authors.lastname: Denning
mesh_terms: D000328:Adult; D000908:Antibodies, Fungal / Q000097:blood; D001230:Aspergillus / Q000276:immunology / Q000302:isolation & purification*; D002175:Candida / Q000276:immunology / Q000302:isolation & purification*; D015331:Cohort Studies; D003550:Cystic Fibrosis / Q000097:blood / Q000276:immunology / Q000503:physiopathology*; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D006969:Hypersensitivity, Immediate / Q000276:immunology / Q000503:physiopathology; D007110:Immunity, Active / Q000276:immunology / Q000502:physiology*; D007073:Immunoglobulin E / Q000097:blood / Q000502:physiology*; D008137:Longitudinal Studies; D008168:Lung / Q000276:immunology / Q000382:microbiology / Q000503:physiopathology; D008297:Male; D011446:Prospective Studies; D012137:Respiratory System / Q000276:immunology / Q000382:microbiology* / Q000503:physiopathology; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology; D014797:Vital Capacity / Q000502:physiology
chemical_list: D000908:Antibodies, Fungal; D007073:Immunoglobulin E