Novel immunologic classification of aspergillosis in adult cystic fibrosis

The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis

“…Baxter et al 11 have recently proposed a novel classification of aspergillosis in adult CF. Using a combination of serologic (total IgE, Af sIgE and sIgG), RT-PCR, and galactomannan (GM) data, they distinguish between non-diseased, CF-ABPA, Af sensitization and Af bronchitis.…”

“…Furthermore, the total IgE cut-off herein has been considerably reduced compared to consensus values used (minimum 500 kU/L) in line with previously published ROC-curve analysis demonstrating that the optimum level for ABPA diagnosis is >185 kU/L, giving 91% sensitivity and 90% specificity. 11 The inclusion of the reduced level in our proposed classification system was validated when one patient meeting our classification criteria for CF-ABPA, i.e. elevated CD203c, total IgE and Af sIgE, but not consensus conference criteria (total IgE > 500 kU/L), developed ABPA as defined by consensus conference criteria shortly after the study conclusion.…”

“…[5][6][7] ABPA affects between 2%-15% of patients with CF (PWCF) and recurrent episodes impact pulmonary function. 1, [8][9][10][11] It manifests as an allergic, hypersensitive, Th2 CD4 + cell-driven response to Af and the diagnosis of ABPA in CF is particularly challenging due to overlapping clinical, immunological and radiological features that are similar to those of a pulmonary exacerbation. To address this, consensus conference criteria were published to aid clinicians in diagnosing CF-ABPA.…”

What is the importance of classifyingAspergillusdisease in cystic fibrosis patients?

“…A new classification for Aspergillus disease in CF Recently, a new classification for aspergillosis in CF has been proposed that integrates two new methods of Aspergillus detection, sputum galactomannan and real-time Aspergillus PCR, alongside established serological markers [22]. 146 adult patients with CF were investigated by ImmunoCap total IgE, specific A. fumigatus IgE, specific A. fumigatus IgG, sputum galactomannan antigen detection and sputum real-time Aspergillus PCR.…”

Identifying rare diseases using electronic medical records: the example of allergic bronchopulmonary aspergillosis

“…Allergic bronchopulmonary aspergillosis (ABPA) is characterised by a hypersensitivity reaction to Aspergillus fumigatus 1, 2 and occurs almost exclusively in patients with asthma or cystic fibrosis 1, 3, 4. Recent estimates suggest that approximately 5.4 million patients have been diagnosed with asthma in the UK, of which around 4.3 million are adults 5, 6.…”