Aspergillus allergy and allergic bronchopulmonary aspergillosis in cystic fibrosis

We have found allergic bronchopulmonary aspergillosis in 8.6% of 105 children with cystic fibrosis (CF). Its development was significantly associated with colonisation of the respiratory tract by Pseudomonas aeroginosa but not necessarily by the use of nebulised antibiotics. At the same time, 30% of the 105 CF children had A. fumigatus growing in their sputum, 30% had positive prick skin tests to A. fumigatus, 23% had a positive IgE antibody to A. fumigatus and 19% positive A. fumigatus precipitins (IgG antibodies). All of these features were significantly associated with the use of nebulised antibiotics but more strongly associated with Pseudomonas colonisation. It is possible that the Pseudomonas facilitates sensitisation to A. fumigatus or, alternatively, that A. fumigatus facilitates colonisation by Pseudomonas. Both hypotheses require investigation.