Response to bronchial provocation and exercise in children with cystic fibrosis

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Abstract
Of 15 cystic fibrosis children with positive skin prick tests to common antigens, 10 gave immediate bronchial reaction to the antigen inhaled and 5 also gave a late reaction; only 1 gave a history of asthma. The antigen most commonly eliciting a positive skin reaction in cystic fibrosis patients is Aspergillus fumigatus. In 6 children tested to this antigen the bronchial response varied; 2 were negative, 1 gave an immediate reaction and 3 gave a dual (immediate and late) reaction. None of the children showed the characteristic pattern of response to exercise seen in asthmatic patients, an initial rise in peak expiratory flow rate [PEFR] followed by a fall greater than 14% below the resting level. Two patients showed an abnormal rise in PEFR during exercise, a pattern described previously in cystic fibrosis. Bronchial allergy, immediate or late, apparently does not completely explain susceptibility to asthma, and other factors may be required, perhaps including the type of bronchial reactivity shown by bronchoconstriction after exercise. The majority of children tested had bronchial allergy, and anti-allergy therapy such as inhaled sodium cromoglycate may have a place in the management of selected patients with cystic fibrosis.