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1 From the Division of Allergy and Infectious Diseases, Department of Medicine, Northwestern University Medical School, Chicago
2 From the General Internal Medicine, Department of Medicine, Northwestern University Medical School, Chicago
3 From the Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Medical School, Chicago
4 From the Departments of Pediatrics and Medicine, University of Washington, Seattle; and Division of Allergy-Immunology, Department of Medicine, Northwestern University Medical School, Chicago
5 From the Divisions of Allergy and Infectious Diseases, Department of Medicine, Northwestern University Medical School, Chicago
Background: Underestimation of allergic bronchopulmonary aspergillosis (ABPA) prevalence in the cystic fibrosis (CF) population is suspected due to nonuniform diagnostic criteria, nonspecific signs and symptoms, assessment during asymptomatic intervals, and physician nonaggressiveness in making the diagnosis.
Objective: To define the prevalence of ABPA in adult patients with CF, as the increased duration of bronchiectasis may increase the probability of Aspergillus fumigatus (Af) colonization. We also sought to determine whether atopy increases the prevalence of ABPA in adults with CF.
Methods: We examined a cross-sectional population of adult patients with CF at the University of Washington for 1 year.
Results: Information was collected on 53 of 65 (82%) patients. Fifteen of 51 (29%) had an immediate skin test reaction to Af, and 30 of 51 (59%) had at least one positive skin test. Increased total serum IgE (>450 IU/mL) was present in 0 of 53; increased IgE-Af and IgG-Af were found in 12 of 53 (23%) and 9 of 53 (17%), respectively; 24 of 53 (45%) had Af-precipitins. Peripheral blood eosinophilia was present in one patient. Eight of 49 (16%) patients' sputum cultures grew Af ABPA-CB (ABPA-central bronchiectasis) was present in one patient and ABPA-S (ABPA-seropositive) in no patients. Atopy was present in 20 of 51 (39%).
Conclusion: There was a low prevalence of ABPA in the adult CF population despite frequent immunologic responses to Af. The prevalence of ABPA was too small to determine an association with atopy.
Key Words: allergic bronchopulmonary aspergillosis • atopy • cystic fibrosis
Submitted on August 22, 1995
Accepted on December 12, 2007
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