Mold Allergy in Cystic Fibrosis Patients

Abstract

Background. Allergic bronchopulmonary aspergillosis (ABPA) significantly impairs respiratory function in patients with cystic fibrosis (CF). According to international studies, the incidence of ABPA in CF patients ranges from 2 to 15%. National publications on this subject are rare. Objectives. To study the prevalence of fungal sensitization and frequency of ABPA in patients with CF in Saint-Petersburg, Russia Methods. We observed 44 patients with CF between 1 and 37 years old (median age, 13 years): 21 males and 23 females. All patients underwent skin tests with six fungal allergens, determination of total IgE level (by enzyme immunoassay) and specific IgE to fungal allergens in serum, and IgG to Aspergillus fumigatus. Microscopic examination of sputum and sputum culture were done. Specific IgE to fungal, domestic and epidermal allergens were determined with multiple allergen simultaneous test-chemiluminescent assay (MAST-CLA; Chemical Diagnostics, Inc., USA). In patients with suspicion of ABPA chest CT scan was performed. Detection of specific serum IgE to fungal allergen (class >=1) was considered as criterion of fungal sensitization. Diagnostic criteria of ABPA 2003 were used. Results. Total serum IgE level varied from 1 to 3250 IU/ml (median, 18). Sensitization to fungi by positive skin prick tests and/or by specific serum IgE level to fungal allergens was identified in 29 patients (66%). The highest frequency of fungal sensitization was connected with Candida spp. (48%), Aspergillus spp. (25%), and Alternaria spp. (25%). Occurrence of sensitization to other fungi was lower: Rhizopus spp., 20%; Penicillium spp., 13%; and Cladosporium spp., 8%. IgG to Aspergillus fumigatus was detected in 10 patients (23%). Sputum culture identified A. fumigatus in 9 patients (20%) and A. niger in 2 (5%). ABPA was diagnosed in 2 patients (5%). In one patient (2%) aspergilloma in the left lung apical segment (S1) was detected. Conclusion. The frequency of fungal sensitization in cystic fibrosis patients was 66%, sensitization to Candida spp. 48%, Aspergillus spp. 25%, and Alternaria spp. 25%. ABPA was diagnosed in 5% patients. In one case aspergilloma of the lung was detected. All patients with cystic fibrosis need allergy screening for timely detection and adequate treatment of ABPA.