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

Florian Gothe, Matthias Kappler, Matthias Griese


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) naïve” 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 naïve 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<0.0001). While treated patients showed improved FEV1 values (+0.2%/year), lung function declined in all untreated groups (range -0.1%/y to -0.8%/y). If t-IgE levels doubled within three months exceeding the 95th percentile, ABPA treatment resulted in improved FEV1 values (p<0.05).

Conclusion: In ABPA diagnosis, analyzing the course of t-IgE levels predicts the effect of treatment on pulmonary outcome.


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Full conference title: 

European Respiratory Society 2016
    • ERS 26th (2016)