IDENTIFICATION OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS IN CYSTIC-FIBROSIS PATIENTS BY RECOMBINANT ASPERGILLUS-FUMIGATUS I A-SPECIFIC SEROLOGY/

Before specific therapy, such as oral corticosteroids, can be commence d it is essential to distinguish full-blown allergic bronchopulmonary aspergillosis (ABPA) from allergy to A. fumigatus in patients with cys tic fibrosis (CF). For this purpose we have evaluated the diagnostic v alue of recombinant A. fumigatus allergen I/a (rAsp fI/a)-specific ser ology in 55 patients with CF. Based on clinical presentation and labor atory data, 10 CF patients had ABPA, 27 had Aspergillus allergy, and 1 8 were not allergic to A. fumigatus (CF control group). The serologic assays revealed a 10-fold increase in rAsp fI/a-specific IgE, a 5-fold increase in rAsp fI/a-specific IgG(1), and a 4-fold increase in rAsp fI/a-specific IgC(4);4 antibodies in ABPA patients compared with the A spergillus allergy and CF control groups. Sera from 11 CF patients wer e analyzed without knowledge of their clinical state or diagnosis of A BPA. All ABPA patients (4 of 11) were accurately identified. We conclu de that rAsp fI/a-specific serology is a highly sensitive and specific test that can be used to identify ABPA reliably in CF patients.