Fungal allergy in asthma–state of the art and research needs

Abstract

Sensitization to fungi and long term or uncontrolled fungal infection are associated with poor control of asthma, the likelihood of more severe disease and complications such as bronchiectasis and chronic pulmonary aspergillosis. Modelling suggests that >6.5 million people have severe asthma with fungal sensitizations (SAFS), up to 50% of adult asthmatics attending secondary care have fungal sensitization, and an estimated 4.8 million adults have allergic bronchopulmonary aspergillosis (ABPA). There is much uncertainty about which fungi and fungal allergens are relevant to asthma, the natural history of sensitisation to fungi, if there is an exposure response relationship for fungal allergy, and the pathogenesis and frequency of exacerbations and complications. Genetic associations have been described but only weakly linked to phenotypes. The evidence base for most management strategies in ABPA, SAFS and related conditions is weak. Yet straightforward clinical practice guidelines for management are required. The role of environmental monitoring and optimal means of controlling disease to prevent disability and complications are not yet clear. In this paper we set out the key evidence supporting the role of fungal exposure, sensitisation and infection in asthmatics, what is understood about pathogenesis and natural history and identify the numerous areas for research studies.

The basophil surface marker CD203c identifies Aspergillus species sensitization in patients with cystic fibrosis

“…[15][16][17] Af sensitization likely facilitates CF-ABPA and multiple factors, including degree of fungal exposure, mucus viscosity, immune status, atopy and age may also have interdependent roles. 12,32,39 Other factors, such as HLA-DR/HLA-DQ subtypes and the presence of single nucleotide polymorphisms in the IL-4 binding site of IL-4 receptor alpha have also been described to associate with development of ABPA. [40][41][42] Longitudinal studies are needed to confirm that Af sensitization routinely precedes ABPA.…”

Serious fungal infections in Ecuador

“…The risk of allergic bronchopulmonary aspergillosis (ABPA) was estimated at 2.5% based on previous studies [23]. The rate of severe asthma with fungal sensitization (SAFS) was estimated as the worst 10% of the total asthma population of whom at least 33% have fungal sensitization [24].…”

Identifying risk factors for exposure to culturable allergenic moulds in energy efficient homes by using highly specific monoclonal antibodies

“…There is limited research assessing how the interaction 83 between occupant behaviours and the built environment regulates the diversity of 84 allergenic fungi . This is important to consider because different 85 genera of allergenic fungi are associated with the development (Reponen et al,86 2011) and exacerbation of asthma , and a phenotype of severe 87 asthma in sensitised individuals (Denning et al, 2014;Denning et al, 2006). Despite neglected (Crameri et al, 2013).…”