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Multicenter Study
. 2025 Mar 10;26(1):95.
doi: 10.1186/s12931-025-03171-3.

High level of initial Aspergillus fumigatus-specific IgE links increased risk of exacerbation in allergic bronchopulmonary aspergillosis patients

Hao Qian #  1 , Jia-Yan Xu #  1 , Rui Fan #  1 , Jing Shi #  2   3 , Hai-Wen Lu  1 , Ling Ye  2   3 , Jia-Wei Yang  1 , Rui Jiang  1 , Li-Sha Zhang  1 , Yi-Fan Wu  1 , Mei-Ling Jin  4   5 , Jin-Fu Xu  6   7
Affiliations
Multicenter Study

High level of initial Aspergillus fumigatus-specific IgE links increased risk of exacerbation in allergic bronchopulmonary aspergillosis patients

Hao Qian et al. Respir Res. .

Abstract

Background: Elevated Aspergillus fumigatus (A. fumigatus)-specific Immunoglobulin E (IgE) is recognized as an essential diagnostic criterion for allergic bronchopulmonary aspergillosis (ABPA). However, it remains unknown whether initial A. fumigatus-specific IgE at acute stage has a role beyond diagnostic purposes.

Method: This two-center retrospective study enrolled 149 acute ABPA patients. Risk factors for one-year exacerbation were analyzed using univariate and multivariate logistic regression. Participants were then divided into a discovery cohort (n = 93) to determine the optimal initial A. fumigatus-specific IgE cut-off value via receiver operating characteristic (ROC) curve, and a validation cohort (n = 56) to confirm exacerbation differences based on this cut-off value.

Result: Multivariate logistic regression analysis revealed that female sex (odds ratio (OR) 2.44, 95% confidence interval (CI) 1.15-5.16, P = 0.020), A. fumigatus-specific IgE (OR 1.05, 95% CI 1.02-1.08, P = 0.002), and bronchiectasis (OR 3.61, 95% CI 1.07-12.21, P = 0.039) were independent risk factors for ABPA exacerbation. In the discovery cohort, the optimal initial cut-off value for A. fumigatus-specific IgE was calculated to be 9.88 kUA/L. And, the validation cohort confirmed that patients with A. fumigatus-specific IgE > 9.88 kUA/L were at higher risk of exacerbation (P = 0.005).

Conclusion: This study highlighted the prognostic utility of initial A. fumigatus-specific IgE at acute stage and found that elevated levels, especially those exceeding 9.88 kUA/L, were associated with increased risks of exacerbation in ABPA patients.

Keywords: Aspergillus fumigatus-specific IgE; Allergic bronchopulmonary aspergillosis; Exacerbation; Prognostic indicator.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Ethics Committees of Shanghai Pulmonary Hospital, Tongji University (No. K18-153 and K18-167) and Zhongshan Hospital, Fudan University (No. B2019-020R and B2021-353). Informed consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of recruitment and exclusion of participants in this study
Fig. 2
Fig. 2
Univariate logistic regression showing predictive factors for exacerbation in ABPA patients
Fig. 3
Fig. 3
Multivariate logistic regression showing predictive factors for exacerbation in ABPA patients
Fig. 4
Fig. 4
ROC curves for A. fumigatus-specific IgE of ABPA patients in the discovery cohort
Fig. 5
Fig. 5
Kaplan–Meier curve for two groups of ABPA patients in the validation cohort
See this image and copyright information in PMC

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