Chest
Volume 110, Issue 2, August 1996, Pages 363-366
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Clinical Investigations: Immunology
A 12-Year Longitudinal Study of Aspergillus Sensitivity in Patients With Cystic Fibrosis

https://doi.org/10.1378/chest.110.2.363Get rights and content

Study 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).

Design

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.

Setting

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

Patients

One hundred eighteen patients with documented CF participated.

Interventions

None.

Measurements and 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.

Section snippets

Patient Population

Patients were enrolled from the CF clinic at Cardinal Glennon Children's Hospital, St. Louis. All patients had been previously diagnosed as having CF with an iontophoric sweat chloride level of 60 mEq/L or greater on a pilocarpine-induced sweat sample of more than 50 mg.10 Institutional Review Board approval was granted and informed consent was obtained for each patient. Patients were evaluated at approximately yearly intervals during routine follow-up visits. The male:female ratio was 65:53

RESULTS

One hundred eighteen patients with CF were evaluated 633 times; 112 of them were non-ABPA patients and 97 of these patients were evaluated more than once (Table 1). Sensitivity to A fumigatus developed with time, but surprisingly, a diminution of positive parameters was also noted. Table 2 shows the number of non-ABPA CF patients who developed positive parameters. Forty-two percent had a positive ST, 42% had a positive precipitin, 54% had a positive IgE-Af, 61% had a positive IgG-Af, and 23%

DISCUSSION

We were not successful in prospectively identifying patients at risk for developing ABPA because no clear pattern of sensitivity emerged in those patients who went on to develop ABPA. The fact that parameters of sensitivity occurred in 89 of 112 patients studied attests to the fact that Aspergillus is a ubiquitous fungus that can elicit an immunologic response. Indeed, El-Dahr et al11 found that 98% of patients with CF in their study had evidence of an IgG antibody response to Asp fI (an 18-kd

ACKNOWLEDGMENTS

We would like to acknowledge the assistance of Gary Albers, MD, Blake Noyes, MD, Bruce Rubin, MD, Mary Ellen Judge, BSN, CPNP, and Patricia Allgeyer, RN.

References (15)

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