Unusual Clustering of Allergic Bronchopulmonary Aspergillosis in Children With Cystic Fibrosis

PEDIATRICS ◽  
1988 ◽  
Vol 82 (6) ◽  
pp. 835-839
Author(s):  
Sabine Maguire ◽  
Patricia Moriarty ◽  
Edward Tempany ◽  
Muiris FitzGerald
Keyword(s):  
Cystic Fibrosis ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Skin Tests ◽  
Immediate Hypersensitivity ◽  
Positive Type ◽  
X Ray ◽  
Suppurative Lung Disease ◽  
Peripheral Blood Eosinophilia

Allergic bronchopulmonary aspergillosis has been recognized in association with cystic fibrosis in children since 1965. Since then, however, there have been a paucity of reports of pediatric cystic fibrosis complicated by allergic bronchopulmonary aspergillosis, and, in most cases, these have been diagnosed retrospectively. A cluster of five acute cases seen during a 4-month period in a single cystic fibrosis center with a systemic illness and deterioration in respiratory status are described. In all five patients, reversible bronchoconstriction and infiltrative changes on x-ray films suggested the diagnosis. This was confirmed by the presence of (1) peripheral blood eosinophilia, (2) elevated total IgE and Aspergillus fumigatus-specific IgE, and (3) circulating serum precipitins against A fumigatus in all cases. All children tested had positive type 1 immediate hypersensitivity to skin tests for A fumigatus, in sputum eosinophilia, and Aspergillus cultured from sputum. Only three of five children were previously noted to be atopic and none had severe advanced suppurative lung disease. All children had previously received bronchodilator therapy and appropriate antibiotics. Following treatment with corticosteroids, acute symptoms and radiologic changes resolved for 1 to 5 months. To date, no children have had recurrence of their allergic bronchopulmonary aspergillosis while receiving alternate-day steroid treatment for 6 months.

scholarly journals BASOPHILE ACTIVATION TEST FOR THE DIAGNOSTICS OF FUNGAL SENSITIZATION IN THE PATIENTS WITH CYSTIC FIBROSIS

2019 ◽  
Vol 21 (5) ◽  
pp. 919-928
Author(s):  
Ya. I. Kozlova ◽  
E. V. Frolova ◽  
A. E. Uchevatkina ◽  
L. V. Filippova ◽  
O. V. Aak ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Stimulation Index ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Basophil Activation Test ◽  
Specific Ige ◽  
Basophil Activation ◽  
Total Ige ◽  
Activation Test ◽  
Fungal Allergens ◽  
Fungal Sensitization

Aspergillus fumigatus colonization in the patients with cystic fibrosis (CF) may cause sensitization against A. fumigatus and/or allergic bronchopulmonary aspergillosis (ABPA), which significantly worsens the course of underlying disease. At the present time, new diagnostic tests are searched for detection of fungal sensitization in these patients. The aim of this work was to evaluate an opportunity of application of basophile activation test with A. fumigatus allergen in vitro using flow cytometry, aiming for identification of fungal sensitization in the CF patients. The study included 190 patients with CF aged 1 to 37 years. All the patients underwent common allergy screening (skin tests with fungal allergens, determination of serum levels of total IgE and specific IgE for the fungal allergens), and mycological examination (microscopy and culture of respiratory substrates). Computed tomography of the chest was performed upon clinical indications. The basophil activation test with the A. fumigatus allergen was performed in 10 CF patients with ABPA, and 10 CF patients without ABPA, in addition to the standard allergological examination. Frequency of sensitization to A. fumigatus in the patients with cystic fibrosis was 27%, the incidence of allergic bronchopulmonary aspergillosis was 5.7%. The number of eosinophils, total IgE and specific IgE levels in CF patients with ABPA were significantly higher than in CF patients without ABPA. In blood of the ABPA patients we have identified 68.5 (52.5-81.5%) of basophilic leukocytes activated by A. fumigatus allergen, with a stimulation index of 17.07 (10.30-27.70). In appropriate comparison group, the stimulation index did not exceed 1.5 (p = 0.000). Direct positive correlation between the levels of specific IgE to A. fumigatus and the number of basophils activated by A. fumigatus allergens was revealed (r = 0.77; р < 0.05). FVC values and the body mass index in CF patients with ABPA were significantly lower when compared with the patients without fungal sensitization. Introduction of the basophil activation test, along with standard techniques, may enable a more differentiated assessment of ABPA development in CF patients. Timely detection of associations between A. fumigatus sensitization and clinical status of CF patients will facilitate early and effective administration of specific therapy.

scholarly journals Evaluation of a New Routine Diagnostic Test for Immunoglobulin E Sensitization to Neuromuscular Blocking Agents

2011 ◽  
Vol 114 (1) ◽  
pp. 91-97 ◽  
Author(s):  
Dominique Laroche ◽  
Sylvie Chollet-Martin ◽  
Pierre Léturgie ◽  
Laure Malzac ◽  
Marie-Claude Vergnaud ◽  
...  
Keyword(s):  
Skin Test ◽  
Quaternary Ammonium ◽  
Immunoglobulin E ◽  
Solid Phase ◽  
Specific Ige ◽  
Neuromuscular Blocking ◽  
Neuromuscular Blocking Agents ◽  
Skin Tests ◽  
Hypersensitivity Reactions ◽  
Immediate Hypersensitivity

Background Neuromuscular blocking agents (NMBA) are responsible for most immediate hypersensitivity reactions during anesthesia, as a result of the presence of a quaternary ammonium ion. The aim of this study was to evaluate the diagnostic performance of a commercial immunoglobulin E (IgE) test (quaternary ammonium morphine [QAM]) for diagnosing sensitivity to NMBA. Methods We tested 168 patients exposed to NMBAs during anesthesia. Of those patients, 54 had an uneventful procedure and 114 had immediate hypersensitivity reactions, and 57 patients had positive skin tests to the administered NMBA, whereas 57 had negative skin tests. Specific IgE concentrations determined with the QAM method based on a morphine solid phase were compared with those obtained with a recommended experimental method with a choline solid phase. Results For the QAM test, a 0.35 kUA/l positivity cutoff was chosen from the receiver operating characteristics curve. QAM-specific IgE was found in 84.2% of skin test-positive reactors (80.7% with the recommended method; no significant difference), and binding was inhibited by the culprit NMBA in 80% of cases. The frequency of QAM-specific IgE positivity was significantly higher in skin test-negative reactors (24.6%) than in controls (9.3%), suggesting NMBA sensitivity. Conclusion Sensitivity of the QAM test (84.2%), together with its simplicity and suitability for routine laboratory use, makes it a valuable tool, in conjunction with skin tests, for diagnosing NMBA sensitivity in patients who react after NMBA injection. The QAM test is of particular interest when skin tests are not available or not reliable or give results poorly compatible with mediator release or clinical features.

Allergic Fungal Sinusitis Associated with Allergic Bronchopulmonary Aspergillosis: An Uncommon Sinobronchial Allergic Mycosis

2007 ◽  
Vol 21 (4) ◽  
pp. 412-416 ◽  
Author(s):  
Jean Jacques Braun ◽  
Gabrielle Pauli ◽  
Philippe Schultz ◽  
André Gentine ◽  
David Ebbo ◽  
...  
Keyword(s):  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Antifungal Drugs ◽  
Sinus Surgery ◽  
Skin Tests ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Positive Skin ◽  
Oral Corticosteroids ◽  
Blood Eosinophils

Background The identification of allergic fungal sinusitis (AFS) is still controversial and much more recent than that of allergic bronchopulmonary aspergillosis (ABPA). Their association has been reported very rarely in the literature. Methods The aim of this study was to present a review of 6 cases of AFS associated with ABPA from a series of 12 cases of AFS and to compare AFS associated with ABPA and isolated AFS. Results All cases of AFS presented with chronic rhinosinusitis. The six cases with AFS and ABPA were atopic, asthmatic, with pulmonary infiltrates (five cases), central bronchiectasis (four cases), and both (three cases). The mycological and immunoallergological features of isolated AFS and AFS associated with ABPA were similar: eosinophilic allergic mucin with noninvasive fungi hyphae, high levels of blood eosinophils, total IgE, specific IgE, IgG, and positive skin tests to Aspergillus. The association of AFS and ABPA was concomitant (two cases) or remote in time (four cases). The treatment with oral corticosteroids and sinus surgery (six cases) associated with antifungal drugs (four cases) led to resolution in three cases, considerable improvement in one case, and therapeutic failure in two cases (follow-up longer than 5 years in all cases). Conclusion Independently of the signs linked to the organs involved (sinuses and bronchi) the mycological and immunoallergological features were similar for AFS and AFS associated with ABPA. AFS and ABPA can be isolated or associated in a sinobronchial allergic mycosis.

scholarly journals Recombinant Allergens Combined with Biological Markers in the Diagnosis of Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis Patients

2010 ◽  
Vol 17 (9) ◽  
pp. 1330-1336 ◽  
Author(s):  
Hélène Fricker-Hidalgo ◽  
Bérangère Coltey ◽  
Catherine Llerena ◽  
Jean-Charles Renversez ◽  
Renée Grillot ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Retrospective Study ◽  
Biological Markers ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Added Value ◽  
Enzyme Linked Immunosorbent Assay ◽  
Serum Samples ◽  
Total Ige ◽  
Specific Igg

ABSTRACT Allergic bronchopulmonary aspergillosis (ABPA) is a frequent complication in cystic fibrosis patients. The diagnosis remains difficult and requires a combination of clinical, radiological, biological, and mycological criteria. The aim of this study was to analyze the added value of two recombinant antigens, rAspf4 and rAspf6, associated with the detection of specific IgG; precipitins; total IgE; and Aspergillus fumigatus in sputum for the diagnosis of ABPA. In a retrospective study, we determined the specific IgE responses to these recombinants in 133 sera of 65 cystic fibrosis patients. We selected an average of five serum samples from each of the 17 patients with ABPA (13 proven and 4 probable ABPA) and from 3 patients with Aspergillus bronchitis and rhinosinusitis. One serum sample for the 45 patients without ABPA was tested. The sensitivity of specific IgE detection against rAspf4 calculated per patient (92.3%) was significantly higher (P < 0.05) than that of rAspf6 (53.8%). When rAspf4 IgE detection was associated with anti-Aspergillus IgG enzyme-linked immunosorbent assay (ELISA) and precipitin detection, the sensitivity rose to 100%. The specificities of rAspf4 and rAspf6 IgE detection were 93.7% and 91.6%, respectively. Other diagnostic criteria had slightly lower specificities (87.5% for anti-Aspergillus IgG ELISA, 89.6% for precipitins, 84.4% for total IgE, and 85.0% for positive A. fumigatus culture in sputum). In conclusion, this retrospective study showed the relevance of rAspf4 IgE detection, in combination with other biological markers (Aspergillus IgG ELISA, precipitins, and total IgE), for improving the biological diagnosis of ABPA.

Immunization with cathepsin L proteinases CL1 and CL2 secreted byFasciola hepaticaelicit a preferential type 1 response based on IgG2a antibodies in rats

2002 ◽  
Vol 76 (3) ◽  
pp. 199-205 ◽  
Author(s):  
A. Bentancor ◽  
L. Piacenza ◽  
C. Carmona
Keyword(s):  
Fasciola Hepatica ◽  
Cathepsin L ◽  
Humoral Response ◽  
Specific Ige ◽  
Igg Subclass ◽  
Antibody Titres ◽  
The Individual ◽  
Peripheral Blood Eosinophilia

AbstractCathepsin L proteinases (CL1 and CL2), the major components ofFasciola hepaticaexcretion/secretion products (E/S) are considered potential antigens of a vaccine against fascioliasis. The humoral response elicited by CL1 and CL2 in rats either immunized with the enzymes or infected withF. hepaticahas been analysed, examining specific IgE and IgG subclass dynamics. The experiment was continued for 10 weeks and peripheral blood eosinophilia was also determined. Infected rats presented peaks of eosinophilia at weeks 3 and 7 post-infection, while those immunized with CL1 and CL2 were no different from controls. Total IgE in infected rats increased up to week 5, reaching 30 μg-1in some cases, then decreased slowly and rising again towards the end of the experiment. Determination of specific IgE, carried out in sera previously absorbed with Protein G-Sepharose, reached a peak in infected rats between weeks 2 and 5, depending on the individual. In immunized rats both total and specific IgE levels remained around the pre-immunization values. With regard to the IgG subclass responses to E/S products, in infected rats IgG1 predominated over IgG2a, and the reverse was true in rats immunized with CL1 and CL2 and tested against the respective antigens. In all cases an increase in IgG1 and IgG2a antibody titres was seen, with maximum levels being reached later (weeks 6–7) in infected rats than in immunized ones (weeks 4–5). No IgG2b or IgG2c responses were detected in any of the groups studied.

scholarly journals Allergic bronchopulmonary aspergillosis in patients with asthma: dynamics of immunological parameters during antimycotic therapy

2016 ◽  
Vol 13 (6) ◽  
pp. 37-42
Author(s):  
Y I Kozlova ◽  
A V Sobolev ◽  
E V Frolova ◽  
A E Uchevatkina ◽  
L V Filippova ◽  
...  
Keyword(s):  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Absolute Number ◽  
Skin Tests ◽  
Immunological Parameters ◽  
Total Ige ◽  
Antimycotic Therapy ◽  
Fungal Allergens ◽  
Ifn Γ ◽  
Serum Total Ige

Background. To determine the frequency of allergic bronchopulmonary aspergillosis in patients with asthma and to study the dynamics of immunological parameters in patients with allergic bronchopulmonary aspergillosis during antimycotic therapy. Methods. During investigation of 176 patients with asthma the group of patients with allergic bronchopulmonary aspergillosis was isolated. Allergological (skin tests with fungal allergens, serum total IgE, specific IgE to fungal allergens), immunological (IFN-γ, IL-10) and mycological (microscopy and culture of respiratory samples) examination was performed. Computer tomography of the chest was done when indicated. Results. In patients with asthma frequency of sensitization to Aspergillus spp. was 27%, with allergic bronchopulmonary aspergillosis - 4%. The increased activity of T-helper type 2 in patients with allergic bronchopulmonary aspergillosis (n=7) was revealed. After itraconazole treatment during 24 weeks serum total IgE reduced (p=0,04), spontaneous and induced production of IFN-γ ratio was normalized. The reduction of the absolute number of eosinophils in 4 (80%) patients, decreased production of sIgE to Aspergillus spp. in 3 (60%) patients were noted. Conclusion. All patients with severe asthma needed additional allergological and mycological examination for the detection of allergic bronchopulmonary aspergillosis. Itraconazole therapy was effective, reduced fungal burden, and resulted to restoring of Th2/Th1 imbalance in patients with allergic bronchopulmonary aspergillosis.

scholarly journals Allergic bronchopulmonary aspergillosis in patients with asthma: Results of a prospective study

2017 ◽  
Vol 89 (8) ◽  
pp. 13-16 ◽  
Author(s):  
Ya I Kozlova ◽  
E V Frolova ◽  
L V Filippova ◽  
A E Uchevatkina ◽  
O V Aak ◽  
...  
Keyword(s):  
Severe Asthma ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Skin Tests ◽  
Asthmatic Patients ◽  
Fungal Allergens ◽  
Allergenic Fungi ◽  
Fungal Allergen ◽  
A Prospective Study ◽  
Fungal Sensitization

Aim. To estimate the frequency of fungal sensitization and the incidence of allergic bronchopulmonary aspergillosis (ABPA) in asthmatic patients. Subjects and methods. A total of 140 asthmatic patients were examined. They underwent allergologic (skin tests for fungal allergens, estimation of total and fungal allergen-specific IgE levels) and mycological (microscopy and inoculation of respiratory biosubstrates) examinations. Chest computed tomography, when indicated, was done. A group of patients with ABPA and that of patients with severe asthma and fungal sensitization were identified. Results. The frequency of fungal sensitization in asthmatic patients was 36%; the main allergenic fungi were Aspergillus and Alternaria. The incidence of ABPA was as high as 4% in the patients with asthma and 11% in those with severe asthma and fungal sensitization. Conclusion. The given current diagnostic criteria will assist practitioners to identify ABPA, to prevent its progression, and to initiate specific anti-inflammatory and antifungal therapy in due time.

Blood basophil activation is a reliable biomarker of allergic bronchopulmonary aspergillosis in cystic fibrosis

2015 ◽  
Vol 47 (1) ◽  
pp. 177-185 ◽  
Author(s):  
Yael Gernez ◽  
Jeffrey Waters ◽  
Bojana Mirković ◽  
Gillian M. Lavelle ◽  
Colleen E. Dunn ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Ex Vivo ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Basophil Activation Test ◽  
Surface Expression ◽  
Specific Ige ◽  
Basophil Activation ◽  
Cross Sectional ◽  
Prospective Longitudinal Study ◽  
Prospective Longitudinal

The diagnosis of cystic fibrosis (CF) patients with allergic bronchopulmonary aspergillosis (ABPA) is clinically challenging, due to the absence of an objective biological test. Since blood basophils play a major role in allergic responses, we hypothesised that changes in their surface activation pattern discriminate between CF patients with and without ABPA.We conducted a prospective longitudinal study (Stanford cohort) comparing basophil activation test CD203c levels by flow cytometry before and after activation withAspergillus fumigatusallergen extract or recombinantAspf1 in 20 CF patients with ABPA (CF-ABPA) and in two comparison groups: CF patients withA. fumigatuscolonisation (AC) but without ABPA (CF-AC; n=13) and CF patients without either AC or ABPA (CF; n=12). Patients were tested every 6 months and when ill with pulmonary exacerbation. We also conducted cross-sectional validation in a separate patient set (Dublin cohort).Basophil CD203c surface expression reliably discriminated CF-ABPA from CF-AC and CF over time. Ex vivostimulation withA. fumigatusextract or recombinantAspf1 produced similar results within the Stanford (p<0.0001) and the Dublin cohorts. CF-ABPA patients were likelier to have elevated specific IgE toA. fumigatusand were less frequently co-infected withStaphylococcus aureus.Basophil CD203c upregulation is a suitable diagnostic and stable monitoring biomarker of ABPA in CF.

scholarly journals Features of fungal sensitization in patients with asthma and cystic fibrosis: the results of a prospective study

2018 ◽  
Vol 15 (2) ◽  
pp. 11-16
Author(s):  
Y I Kozlova ◽  
E V Frolova ◽  
Y V Borzova ◽  
A V Sobolev ◽  
E V Burygina ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Specific Ige ◽  
Test System ◽  
Candida Spp ◽  
Ige Antibodies ◽  
Fungal Allergens ◽  
Patients At Risk ◽  
Fungal Sensitization

Background. To estimate the frequency of fungal sensitization and allergic bronchopulmonary aspergillosis in patients with asthma or cystic fibrosis. Methods. The study included 205 patients with asthma and 190 patients with cystic fibrosis. For detection of fungal sensitization specific IgE antibodies in the blood serum with «AllergoELISA-specific IgE» test system and biotinylated fungal allergens were determined. Mycological examination included microscopy and cultural study of respiratory biomaterials. According to the indications, a CAT scan of the chest was performed. Results. The incidence of fungal sensitization in patients with asthma was 35,6%, CI [29,1%; 42,6%], in patients with cystic fibrosis - 56,8% [49,5%; 64%]. In patients with severe asthma the main fungal allergens were Alternaria spp. (70%) and Aspergillus spp. (60%); in patients with cystic fibrosis: Candida spp. - 73%, Alternaria spp. - 34%, Aspergillus spp. - 27%. The incidence of allergic bronchopulmonary aspergillosis (ABPA) in patients with asthma was 5,3%, in patients with cystic fibrosis - 5,7%. Conclusion Early detection of ABPA in patients with asthma and cystic fibrosis is very important as it changes the therapeutic measures of patients’ management and prevents progression of bronchiectasis and respiratory failure. Determination of specific Aspergillus spp. IgE antibodies in vitro is a necessary stage of diagnosis of ABPA in patients at risk.

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