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(Chest. 1996;110:363-366.)
© 1996 American College of Chest Physicians

A 12-Year Longitudinal Study of Aspergillus Sensitivity in Patients With Cystic Fibrosis

Patricia S. Hutcheson BA1; Raymond G. Slavin MD1; Alan P. Knutsen MD2; and Anthony J. Rejent MD3

1 From the Department of Internal Medicine; and Division of Allergy and Immunology, St. Louis University Health Sciences Center
2 From the Department of Pediatrics; and Division of Allergy and Immunology, St. Louis University Health Sciences Center
3 From the Department of Pediatrics; and Division of Pulmonology, St. Louis University Health Sciences Center

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% 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.

Key Words: allergic sensitization • aspergillosis • Aspergillus • cystic fibrosis

Submitted on February 6, 1995
Accepted on March 13, 1996




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