Allergic bronchopulmonary aspergillosis in cystic fibrosis

ABSTRACT. We determined prospectively over a 12-month period the importance of the fungus Aspergillus in patients with cystic fibrosis.
Aspergillus species was cultured from 10 out of 116 children and adolescents (8.6%), and from 25 of the 1073 sputa (2.3%) collected from these patients. Eighteen of these subjects (15.5%) had positive allergen skin prick tests to Aspergillus species or Aspergillus fumigatus . Fifty-three patients (13%) had blood collected for precipitins and 7 (13%) exhibited type III hypersensitivity to Aspergillus fumigatus . Although 26% had an IgE greater than 200 I.U./ml, only one patient had an IgE greater than 1,000 I.U./ml. We found no evidence of an association between severity of lung disease and either colonisation by or sensitisation to Aspergillus .
No patient fulfilled all our criteria for the diagnosis of allergic bronchopulmonary aspergillosis (ABPA). One teenager (with wheezing, pulmonary infiltrate, positive skin tests, positive sputum culture and markedly elevated IgE) may have had an episode of ABPA. We studied three other children with co-existent asthma in whom it was difficult to establish whether the asthma was related to sensitivity to Aspergillus .
We conclude that ABPA is an uncommon complication of cystic fibrosis in our clinic.