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Sensitization to Aspergillus fumigatus and lung function in children with cystic fibrosis
C Wojnarowski1, I Eichler, C Gartner
1University Children's Hospital and the Children's Department, Wilhelminenspital, Vienna, Austria.
Insights
Aspergillus fumigatus sensitization in children with cystic fibrosis (CF) is linked to reduced lung function (LF), especially when IgE levels are high. This suggests a need for targeted monitoring in CF patients with Af sensitization and elevated IgE.
Area of Science:
- Pediatric Pulmonology
- Clinical Immunology
- Microbiology
Background:
- Colonization with Aspergillus fumigatus (Af) is common in pediatric cystic fibrosis (CF) patients.
- The clinical significance of Af sensitization in CF, particularly its impact on lung function, requires further elucidation.
Purpose of the Study:
- To investigate the association between Aspergillus fumigatus sensitization and lung function (LF) in children with CF.
- To determine if elevated IgE levels modify the impact of Af sensitization on LF in CF patients.
Main Methods:
- A cohort of 118 children with CF underwent annual assessments of total IgE, specific IgE to Af, and skin prick tests for Af.
- Lung function parameters were measured repeatedly over a mean follow-up of 2.2 years.
- Linear regression analyses, adjusted for covariates, were used to assess the relationship between Af sensitization and LF, with subgroup analyses based on IgE levels.
Main Results:
- Twenty-six percent of children with CF were sensitized to Af.
- Af sensitization was associated with significantly lower FEV1 and FEF(25-75) values after adjusting for confounders.
- The negative impact on lung function and evidence of more rapid decline were primarily observed in Af-sensitized patients with elevated total IgE levels.
Conclusions:
- Aspergillus fumigatus sensitization, particularly in the context of elevated IgE, is associated with impaired lung function in children with cystic fibrosis.
- These findings highlight the importance of monitoring Af sensitization and IgE levels in pediatric CF patients for early detection of lung function decline.
Abstract:
Colonization with Aspergillus fumigatus (Af) constitutes a common finding in children with cystic fibrosis (CF). The relationship between sensitization to Af and lung functon (LF) was studied in 118 patients with CF (61 girls and 57 boys; mean age: 14.3 yr; SD: 7 yr). Mean follow up was 2.2 yr. On average, 8.1 (SD: 4.8) LF tests were performed per patient. Measurement of total IgE and specific IgE antibodies to Af, and a skin prick test (SPT) for Af, were done once a year. Thirty-one children (26%) were sensitized to Af. On average, LF parameters were not significantly different in Af-sensitized children than in nonsensitized children. Linear regression analyses were performed, using the repeated measures design. With adjustment for gender, age, height, and weight, sensitization to Af was associated with lower values of FEV1 (beta = -0.209; p < 0.05) and FEF(25-75) (beta = -0.356; p < 0.01). Analysis of different subgroups of sensitization demonstrated the effect on LF only in Af-sensitized patients with elevated total IgE levels, and not in Af-sensitized patients with normal IgE levels. Furthermore, there was evidence for a more rapid decline in LF for Af-sensitized patients with elevated total IgE levels than in those with normal IgE levels. We conclude that sensitization to Af in the presence of increased IgE values is associated with lower LF values in children with CF.