Severe Asthma with Fungal Sensitization

Abstract

A new phenotype of asthma has been described recently, namely severe asthma with fungal sensitization (SAFS). SAFS can be conceptualized as a continuum of fungal sensitization, with asthma at one end and allergic bronchopulmonary aspergillosis at the other. It is diagnosed by the presence of severe asthma, fungal sensitization, and exclusion of allergic bronchopulmonary aspergillosis. Because of the paucity of data and ambiguity in diagnostic criteria, SAFS is currently more of a diagnosis of exclusion than a specific entity. Treatment of SAFS initially should be similar to that of severe asthma, including the use of omalizumab. The potential role of itraconazole as a specific therapy in SAFS requires more evidence before it can be incorporated in routine practice. An urgent need exists for data regarding the prevalence, natural history, and clinical relevance of SAFS so that its exact characterization and importance as a specific subtype of asthma can be clearly defined. This review summarizes the current understanding of the pathogenesis, diagnosis, and management of SAFS.

Treatment options in severe fungal asthma and allergic bronchopulmonary aspergillosis

“…SAFS patients do not meet the necessary constellation of clinical, serological and radiological criteria for a diagnosis of ABPA, usually because total IgE levels are ,1000 IU?mL -1 and/or key radiographic findings, such as mucoid impaction or bronchiectasis, are lacking. As noted previously, the link between fungal sensitisation and severe asthma has been increasingly recognised as a significant piece of the larger asthma puzzle [1][2][3][4][5][6][7][8][9]. Recently this association between fungal sensitisation and the severe asthma phenotype has been further supported by significant correlations between indoor Aspergillus spore air sample concentrations, recovery of fungi (most commonly but not solely A. fumigatus) from respiratory tract cultures and more severe clinical asthma [97,98].…”

“…Evidence has mounted that fungal sensitisation is associated with a more severe asthma phenotype [2][3][4][5][6][7][8]. Thus, an important identifiable subgroup of asthma, termed severe asthma with fungal sensitisation (SAFS), has emerged [4,9]. Identification of SAFS as a recognisable asthma phenotype appears to carry important therapeutic implications.…”

Home Environmental Fungus - The Hidden Killer

“…Aspergillus fumigatus induced pulmonary disease may or may not involve elevated serum IgE or fungal colonization [4][5][6]; luckily though both were positive in this child. Incidence of Interstitial lung disease is 30/100000 individual [7] of which that HP was less than 2%.…”

Allergic Bronchopulmonary Aspergillosis : An interesting presentation

“…The frequency of ABPM is negligible compared to that of ABPA. [9] The causative agent is ubiquitous in the environment, hence it is easy for susceptible people inhale their spores regularly, leading to a constant exposure to an antigenic stimulus. Genetic susceptibility to the agent plays a very important role in the pathogenesis of ABPA.…”