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Clinical relevance of Aspergillus fumigatus sensitization in cystic fibrosis.
Clin. Exp. Allergy, DOI: 10.1111/cea.13557 (2020)
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-gamma, 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.
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Publication type
Article: Journal article
Document type
Scientific Article
Keywords
Aspergillus Fumigatus ; Basic Mechanisms ; Bronchial Allergen Provocation ; Clinical Immunology ; Cystic Fibrosis ; Ige; Allergic Bronchopulmonary Aspergillosis; Airway Inflammation; Immune-response; Induced Sputum; Lung-function; Expression; Ige; Provocation; Guidelines; Children
Language
english
Publication Year
2020
Prepublished in Year
2019
HGF-reported in Year
2019
ISSN (print) / ISBN
0954-7894
e-ISSN
1365-2222
Journal
Clinical & Experimental Allergy
Publisher
Wiley
Publishing Place
111 River St, Hoboken 07030-5774, Nj Usa
Reviewing status
Peer reviewed
Institute(s)
Institute for Allergy Research (IAF)
POF-Topic(s)
30202 - Environmental Health
Research field(s)
Allergy
PSP Element(s)
G-505400-001
WOS ID
WOS:000509030000001
Scopus ID
85078682691
PubMed ID
31886564
Erfassungsdatum
2020-02-05