Florian Gothe1, Matthias Kappler1, Matthias Griese2. 1. Dr von Haunersches Kinderspital, University of Munich, German Center for Lung Research (DZL), Munich, Germany. 2. Dr von Haunersches Kinderspital, University of Munich, German Center for Lung Research (DZL), Munich, Germany. Electronic address: Matthias.griese@med.uni-muenchen.de.
Abstract
BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder contributing to lung disease in cystic fibrosis (CF) and challenging to diagnose. OBJECTIVE: This study analyzed the predictive value of increasing total IgE (t-IgE) levels in a CF cohort alongside with clinical and serologic data. METHODS: A total of 387 children and young adults were followed from 2000 to 2006 and retrospectively classified into 6 groups. Patients with t-IgE levels < 95th percentile and without specific Aspergillus fumigatus (Af)-IgE were classified as "Naïve," those with Af-specific IgE (Af-sIgE) as "Sensitized." Patients with elevated t-IgE at entrance and Af-sIgE were labeled "Former ABPA," and those without, as "High t-IgE." Patients whose t-IgE values started normal and exceeded the 95th percentile during the study were labeled either "ABPA at risk" if Af-sIgE-positive or "Rising t-IgE" if not. Courses of t-IgE over time were divided into episodes with increasing IgE (ΔIgE) and related to pulmonary outcome. RESULTS: A total of 125 patients were classified Naïve (32%), 64 Sensitized (17%), 49 ABPA at risk (13%), 32 Rising t-IgE (8%), 102 Former ABPA (26%), and 15 High t-IgE (4%). A total of 874 ΔIgE episodes were accompanied by forced expiratory volume in 1 second (FEV1) declines (r = -0.21, P < .0001). Steroid treatment of severest ΔIgE episodes resulted in improved long-term pulmonary outcomes (P < .01). This FEV1 preservation effect was only detectable if t-IgE levels at least doubled within 3 months and exceeded the 95th age-specific percentile (P < .05). CONCLUSIONS: ΔIgE obtained from the course of t-IgE levels may be helpful in diagnosing treatment requiring ABPA and predicts the effect of systemic steroid treatment on pulmonary outcome.
BACKGROUND:Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder contributing to lung disease in cystic fibrosis (CF) and challenging to diagnose. OBJECTIVE: This study analyzed the predictive value of increasing total IgE (t-IgE) levels in a CF cohort alongside with clinical and serologic data. METHODS: A total of 387 children and young adults were followed from 2000 to 2006 and retrospectively classified into 6 groups. Patients with t-IgE levels < 95th percentile and without specific Aspergillus fumigatus (Af)-IgE were classified as "Naïve," those with Af-specific IgE (Af-sIgE) as "Sensitized." Patients with elevated t-IgE at entrance and Af-sIgE were labeled "Former ABPA," and those without, as "High t-IgE." Patients whose t-IgE values started normal and exceeded the 95th percentile during the study were labeled either "ABPA at risk" if Af-sIgE-positive or "Rising t-IgE" if not. Courses of t-IgE over time were divided into episodes with increasing IgE (ΔIgE) and related to pulmonary outcome. RESULTS: A total of 125 patients were classified Naïve (32%), 64 Sensitized (17%), 49 ABPA at risk (13%), 32 Rising t-IgE (8%), 102 Former ABPA (26%), and 15 High t-IgE (4%). A total of 874 ΔIgE episodes were accompanied by forced expiratory volume in 1 second (FEV1) declines (r = -0.21, P < .0001). Steroid treatment of severest ΔIgE episodes resulted in improved long-term pulmonary outcomes (P < .01). This FEV1 preservation effect was only detectable if t-IgE levels at least doubled within 3 months and exceeded the 95th age-specific percentile (P < .05). CONCLUSIONS: ΔIgE obtained from the course of t-IgE levels may be helpful in diagnosing treatment requiring ABPA and predicts the effect of systemic steroid treatment on pulmonary outcome.