Severe Fungal Asthma: A Role for Biologics and Inhaled Antifungals

Moss, Richard B.

doi:10.3390/jof9010085

Cited by 12 publications

(5 citation statements)

References 88 publications

(100 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In the last two decades, several trials of monoclonal antibodies against IgE, interleukin (IL)-5, IL-5 receptor (IL-5R), IL-4 receptor α (IL-4Rα) and thymic stromal lymphopoietin (TSLP) have demonstrated clinical benefit in severe eosinophilic asthma [ 158 – 161 ]. Biological agents are likely helpful in stable treatment-dependent ABPA based on case reports and small case series [ 41 , 134 , 162 ]. Omalizumab is a potential therapeutic approach since ABPA is associated with elevated IgE levels.…”

Section: Resultsmentioning

confidence: 99%

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Agarwal,

Sehgal,

Muthu

et al. 2024

Eur Respir J

View full text Add to dashboard Cite

BackgroundThe ISHAM working group proposed recommendations for managing allergic bronchopulmonary aspergillosis (ABPA) nearly a decade ago. There is a need to update these recommendations due to advances in diagnostics and therapeutics.MethodsAn international expert group was convened to develop guidelines for managing ABPA (caused byAspergillusspp.) and allergic bronchopulmonary mycosis (ABPM, fungi other thanAspergillusspp.) in adults and children using a modified Delphi method (two online rounds and one in-person meeting). We defined consensus as ≥70% agreement or disagreement. The terms “recommend” and “suggest” are used when the consensus was ≥70% and <70%.ResultsWe recommend screening forA. fumigatussensitization using fungus-specific IgE in all newly diagnosed adult asthmatics at tertiary care but only difficult-to-treat asthmatic children. We recommend diagnosing ABPA in those with predisposing conditions or compatible clinico-radiological presentation, with a mandatory demonstration of fungal sensitization and serum total IgE ≥500 IU·mL−1and two of the following: fungal-specific IgG, peripheral blood eosinophilia, or suggestive imaging. ABPM is considered in those with an ABPA-like presentation but normalA. fumigatus-IgE. Additionally, diagnosing ABPM requires repeated growth of the causative fungus from sputum.We do not routinely recommend treating asymptomatic ABPA patients. We recommend oral prednisolone or itraconazole monotherapy for treating acute ABPA (newly diagnosed or exacerbation), with prednisolone and itraconazole combination only for treating recurrent ABPA exacerbations. We have devised an objective multidimensional criterion to assess treatment response.ConclusionWe have framed consensus guidelines for diagnosing, classifying, and treating ABPA(M) for patient care and research.

show abstract

Section: Resultsmentioning

confidence: 99%

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Agarwal,

Sehgal,

Muthu

et al. 2024

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Our study investigated the role of A. fumigatus in severely asthmatic and SAFS patients through measurement of total serum IgE (T-IgE), A. fumigatus specific IgE (Asp-IgE) and A. fumigatus galactomannan antigen ELISA test. Similarly, a recent study by Moss et al highlighted that there should be an increased focus on A. fumigatus as a commonly isolated species in respiratory allergic conditions; although others may be involved, A. fumigatus remains the main pathogenic fungal element encountered in the vast majority of cases [15].…”

Section: Discussionmentioning

confidence: 99%

Association between severity of asthma and fungal sensitization in severely asthmatic patients

Eldeen

Elkolaly

Sharshar

et al. 2023

Microbes and Infectious Diseases

View full text Add to dashboard Cite

Background: Fungal sensitization is usually associated with increased asthmatic severity, morbidity and mortality, including higher rates of hospital and intensive care admission. However, the possible association between fungal airway colonization with regard to sensitization remains controversial. Objectives: to investigate the presence of severe asthma with fungal sensitization among asthmatic patients and to find evidence of Aspergillus fumigatus (A. fumigatus) role in severely asthmatic patients. Methods: this study investigated forty asthmatic patients and twenty controls. Demographic data of all subjects within the study was collected, as well as total serum IgE, A.fumigatus specific IgE and A. fumigatus galactomannan antigen ELISA test. Results: our results showed significant elevation of total IgE, Aspergillus specific IgE and A. fumigatus galactomannan antigen in 75% of severely asthmatic patients, compared to patients with mild asthma and negative values in control. Conclusion:We report a high percent of A. fumigatus colonization among severely asthmatic patients. This supports the hypothesis of the role of fungal elements colonization in the airways of patients with severe asthma.

show abstract

“…A real-world study highlights the potential clinical utility of mepolizumab or benralizumab (anti-IL-5/5R therapy) in patients with SAFS, with improvements in exacerbation frequency and patient-reported outcomes, and reduction in maintenance dose of oral corticosteroids over a 48-week treatment period [ 53 ]. Despite the above, the role of itraconazole and type-2-targeted biologicals in managing SAFS requires further evaluation before being considered as a first-line treatment for this specific asthma phenotype [ 54 ].…”

Section: Allergic Fungal Diseasesmentioning

confidence: 99%

Clinical Manifestations of Human Exposure to Fungi

Oliveira

Lisboa

et al. 2023

JoF

View full text Add to dashboard Cite

Biological particles, along with inorganic gaseous and particulate pollutants, constitute an ever-present component of the atmosphere and surfaces. Among these particles are fungal species colonizing almost all ecosystems, including the human body. Although inoffensive to most people, fungi can be responsible for several health problems, such as allergic fungal diseases and fungal infections. Worldwide fungal disease incidence is increasing, with new emerging fungal diseases appearing yearly. Reasons for this increase are the expansion of life expectancy, the number of immunocompromised patients (immunosuppressive treatments for transplantation, autoimmune diseases, and immunodeficiency diseases), the number of uncontrolled underlying conditions (e.g., diabetes mellitus), and the misusage of medication (e.g., corticosteroids and broad-spectrum antibiotics). Managing fungal diseases is challenging; only four classes of antifungal drugs are available, resistance to these drugs is increasing, and no vaccines have been approved. The present work reviews the implications of fungal particles in human health from allergic diseases (i.e., allergic bronchopulmonary aspergillosis, severe asthma with fungal sensitization, thunderstorm asthma, allergic fungal rhinosinusitis, and occupational lung diseases) to infections (i.e., superficial, subcutaneous, and systemic infections). Topics such as the etiological agent, risk factors, clinical manifestations, diagnosis, and treatment will be revised to improve the knowledge of this growing health concern.

show abstract

Severe Fungal Asthma: A Role for Biologics and Inhaled Antifungals

Cited by 12 publications

References 88 publications

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses

Association between severity of asthma and fungal sensitization in severely asthmatic patients

Clinical Manifestations of Human Exposure to Fungi

Contact Info

Product

Resources

About