CYSTIC-FIBROSIS AND RESPIRATORY ALLERGY I N CHILDREN

Allergy often raises diagnostic problems in the context of cystic fibr osis. Several pathophysiological conditions related to inflammation, e ither primary or secondary to allergy, must be distinguished. IgE and/ or IgG immunological reaction mediated by Aspergillus, almost constant during the course of the disease, precede bronchopulmonary allergic a spergillosis which affects 10 per cent of cystic fibrosis children. Se nsitization to usual respiratory allergens, responsible for allergic a sthma, is not more frequent than in the general population. Bronchial hyperreactivity and clinical wheezing can be related to the stage of c ystic fibrosis and unrelated to allergy. The constant inflammation dur ing cystic fibrosis can precede or be related to chronic infection (ba cterial, but also fungal, viral, or due to atypical bacteria) rather t han to allergy. The only well defined treatment of allergy in cystic f ibrosis at the present time is that of bronchopulmonary allergic asper gillosis, which essentially involves the use of corticosteroids. In th e future, a better understanding of the mechanisms involved in inflamm ation, whether or not it is related to allergy, should allow more targ eted anti inflammatory treatments, especially directed towards' the ex pression of cytokines and their possible harmful actions on protein cy stic fibrosistrans-membrane conductance regulator.