Fungal allergy in adult cystic fibrosis

Introduction Since 1995, the reported incidence and diversity of fungi as lung pathogens in Cystic Fibrosis (CF) has increased. There is emerging evidence that fungi may cause infection but hypersensitivity remains the most common manifestation. This study set out to establish the frequency of fungal atopy in an adult CF cohort. Methods 46 patients at the Manchester Adult CF Unit underwent immediate hypersensitivity skin prick testing (SPT) to 5 fungal allergens and 5 common allergens. Wheals ≥3mm after 15 minutes were considered positive. Blood was taken for total IgE and fungal specific IgEs by UniCap immunoassay (class ≥1 is consistent with atopy and >2 with allergic bronchopulmonary mycosis (ABPM)). Results 76% of patients demonstrated a ≥class 1 specific IgE response to 1 or more fungal allergens. Aspergillus fumigatus 67%, Alternaria alternata 30%, Cladosporium herbarum, 15%, Candida albicans 15%, Penicillium notatum 48%. SPT had similar results: A.fumigatus 74%, A.alternata 19%, C.herbarum 14%, C.albicans 28%, P.notatum 37%. 19 (46%) patients demonstrated a >Class 2 response to 1 or more fungal allergens. Fungal atopy was more common in patients with atopy to common allergens. 32 (70%) patients demonstrated positive SPT to 1 or more common allergens. Of those with no positive SPT to common allergens, 27% had fungal atopy whereas of those with positive SPT 68% demonstrated fungal atopy. Total IgE was also associated with fungal atopy. Patients with an IgE>500 demonstrated on average 4 out of 5 positive reactions. Patients with an IgE