Changes in total IgE levels predict pulmonary outcome in cystic fibrosis related allergic bronchopulmonary aspergillosis

Abstract

Background: Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity disorder contributing to lung disease in cystic fibrosis (CF). Although different criteria have been proposed diagnosis of ABPA in clinical practice remains challenging. Objectives: This study analyzed the predictive value of total IgE (t-IgE) levels in a CF cohort alongside with clinical and serologic data. Methods: 387 children and young adults were followed from 2000 to 2006 and retrospectively classified into four groups. Patients showing t-IgE levels below the 95th percentile were categorized as “Aspergillus fumigatus (Af) naive” and “AS sensitized” if specific Af-IgE were present. The term “Former ABPA” was used in patients with elevated t-IgE levels at study entrance, while the “ABPA at risk” group contained patients whose t-IgE values exceeded the 95th percentile during the study period. The t-IgE courses were divided into episodes of change (ΔIgE episodes) and effects of steriod treatment on pulmonary outcome were assessed. Results: 125 (32%) patients were found to be Af naive and 64 (17%) were Af sensitized. 81 ABPA at risk patients (21%) and 116 Former ABPA patients (30%) had elevated t-IgE levels. 874 ΔIgE episodes were identified and accompanied by FEV1 declines (r=-0.21, p Conclusion: In ABPA diagnosis, analyzing the course of t-IgE levels predicts the effect of treatment on pulmonary outcome.