Genetic and Developmental Disorders |

Predominance of Allergic Bronchopulmonary Aspergillosis (ABPA) in African Americans With Cystic Fibrosis FREE TO VIEW

Sumaira Malik, MBBS; Nauman Chaudary, MBBS
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UMMC, Jackson, MS

Chest. 2013;144(4_MeetingAbstracts):587A. doi:10.1378/chest.1675284
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SESSION TITLE: Cystic Fibrosis/ Bronchiectasis Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Factors associated with Allergic bronchopulmonary aspergillosis (ABPA) and Cystic Fibrosis (CF) include age, gender, atopy, severity of lung disease and colonization with Pseudomonas. Because of the difficulties of recognizing ABPA in context of cystic fibrosis as there are overlapping clinical, radiographic, microbiologic and immunologic features common to both diseases, recognizing ABPA in CF can be challenging and often delayed. This can potentially lead to decline in lung function starting early in life. Considering that CF patients undergo multiple medication treatments early on during the course of their illness with resultant alterations in their immunity, anti-aspergillus fumigatus IgE may be more predictive of ABPA diagnosis and severity than the stringent diagnostic criteria itself. We hypothesize that ABPA is predominant in African American adults with CF as compared to Caucasians and consider serologic specific Immunoglobulin E (IgE) levels as a gold standard for the diagnosis of ABPA.

METHODS: We did a retrospective chart review of our adult cystic fibrosis center patients enrolled in cystic fibrosis registry. Prevalence of ABPA was compared in African Americans and Caucasians. Patients were diagnosed as having ABPA if serum anti-aspergillus fumigatus IgE levels were elevated as confirmed on radioallergosorbent test (RAST).

RESULTS: Five out of six African American CF patients had elevation of total IgE levels. Two African American had elevated anti-aspergillus fumigatus IgE levels suggesting a diagnosis of ABPA. Three African Americans with significant elevation of total IgE did not have anti-aspergillus fumigatus IgE levels drawn. Six out of forty nine Caucasian CF patients had elevated anti-aspergillus IgE levels and total IgE levels. Three Caucasians had elevated IgE total but did not have anti-aspergillus fumigatus IgE drawn. F508 del genotype was present in all caucasian patients with ABPA and CF.

CONCLUSIONS: 1. Although incidence of CF is lower in African American population, prevalence of ABPA may be higher among those diagnosed with CF. 2. Anti-aspergillus fumigatus IgE levels are rapid and cost effective in ABPA resulting in early treatment rather than following all of stringent criteria. 3. Simplified criteria in ABPA may also lead to earlier recognition of ABPA and may assist with preservation of lung function in CF patients if treated early.

CLINICAL IMPLICATIONS: Anti-aspergillus fumigatus therapy with anti IgE may also prove to be of significant benefit in CF patient with ABPA.

DISCLOSURE: The following authors have nothing to disclose: Sumaira Malik, Nauman Chaudary

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