Clinical relevance of Aspergillus fumigatus sensitization in cystic fibrosis

Clinical relevance of Aspergillus fumigatus sensitization in cystic fibrosis

Rationale The clinical relevance of sensitization to Aspergillus (A) fumigatus in cystic fibrosis (CF) is unclear. Some researchers propose that specific A fumigatus IgE is an innocent bystander, whereas others describe it as the major cause of TH‐2‐driven asthma‐like disease. Objectives Lung functi...

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Published in:Clinical and experimental allergy Vol. 50; no. 3; pp. 325 - 333
Main Authors: Eickmeier, Olaf, Zissler, Ulrich M., Wittschorek, Julia, Unger, Frederike, Schmitt‐Grohé, Sabina, Schubert, Ralf, Herrmann, Eva, Zielen, Stefan
Format: Journal Article
Language:English
Published: England Wiley Subscription Services, Inc 01-03-2020
Subjects:
Allergens
Aspergillus fumigatus
Asthma
basic mechanisms
bronchial allergen provocation
clinical immunology
Cystic fibrosis
Foxp3 protein
IgE
Immunoglobulin E
Inflammation
Leukocytes (eosinophilic)
Lung diseases
Respiratory function
Sputum
Transcription factors
bronchial allergen provocation
Aspergillus fumigatus
basic mechanisms
IgE
clinical immunology
cystic fibrosis
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Summary:Rationale The clinical relevance of sensitization to Aspergillus (A) fumigatus in cystic fibrosis (CF) is unclear. Some researchers propose that specific A fumigatus IgE is an innocent bystander, whereas others describe it as the major cause of TH‐2‐driven asthma‐like disease. Objectives Lung function parameters in mild CF patients may be different in patients with and without A fumigatus sensitization. We aimed to ascertain whether allergen exposure to A fumigatus by bronchial allergen provocation (BAP) induces TH‐2 inflammation comparable to an asthma‐like disease. Methods A total of 35 patients, aged 14.8 ± 8.5 years, and 20 healthy controls were investigated prospectively. The patients were divided into two groups: group 1 (n = 18): specific (s)IgE negative, and group 2 (n = 17): sIgE positive (≥0.7 KU/L) for A fumigatus. Lung function, exhaled NO, and induced sputum were analysed. All sensitized patients with an FEV1 > 75% (n = 13) underwent BAP with A fumigatus, and cell counts, and the expression of IL‐5, IL‐13, INF‐γ, and IL‐8 as well as transcription factors T‐bet, GATA‐3, and FoxP3, were measured. Results Lung function parameters decreased significantly compared to controls, but not within the CF patient group. After BAP, 8 of 13 patients (61%) had a significant asthmatic response and increased eNO 24 hours later. In addition, marked TH‐2‐mediated inflammation involving eosinophils, IL‐5, IL‐13, and FoxP3 became apparent in induced sputum cells. Conclusion Our study demonstrated the clinical relevance of A fumigatus for the majority of sensitized CF patients. A distinct IgE/TH‐2‐dominated inflammation was found in induced sputum after A fumigatus exposure.
ISSN:0954-7894
1365-2222
DOI:10.1111/cea.13557