S139 Serological classification of aspergillus disease in childhood

Abstract

Introduction and objectives Aspergillus lung disease is an important cause of morbidity in people with CF. Previously, latent class analysis has been used to classify aspergillus disease in adult CF patients based on serology and the detection of aspergillus in respiratory samples.1 The aim of this study was to classify aspergillus disease pragmatically using serological results obtained as part of the annual review for children and young people with CF, and to assess how the prevalence of disease phenotypes so derived change with age. Methods Longitudinal annual review data were retrospectively collated for all children with CF from two centres within a large regional network. Using an algorithm agreed by the investigators prior to the study and based on Aspergillus fumigatus specific IgE and Aspergillus specific IgG (or aspergillus precipitins), children with CF were classified serologically as having no aspergillus disease, serological allergic bronchopulmonary aspergillosis (sABPA), aspergillus sensitisation (AS) or aspergillus bronchitis (AB). Additional parameters collected included respiratory culture of aspergillus within the last year, total IgE, BMI, lung function (FEV1) and whether an episode of clinical ABPA (cABPA) had occurred. Results Analysis of 1267 years of longitudinal annual review data was undertaken for 137 children. Serological evidence of AB increased from 0% over childhood to 32% by 16 years (figure 1). Serological evidence of AS and sABPA was between 10%–30% and 5%–22% respectively for most years. In contrast, No aspergillus disease decreased over childhood and adolescence from 100% to 22% at 16 years. Nineteen (14%) children had at least one episode of cABPA. Serological evidence of AS or sABPA was present in ˜70% at annual review the year before a first episode of cABPA. Conclusions We have shown in a large cohort of children and adolescents with CF, that serological evidence of AB appears to increase over childhood and adolescence. We have also shown that most first episodes of cABPA are preceded by serological evidence of AS or sABPA at the last annual review. Future work should investigate further the temporal relationships between aspergillus serology and the development of cABPA and AB in childhood. Reference Baxter CG, et al. JACISeptember 2013;132(3):560–566.