The role of fungal sensitisation in clinical presentation in patients with chronic obstructive pulmonary disease

Abstract

Atopic patients with chronic obstructive pulmonary disease (COPD) demonstrate more severe symptoms than their non-atopic counterparts. Also, Aspergillus hypersensitivity is known in COPD. However, allergic sensitisation to non-Aspergillus fungi has never been studied in COPD patients. To evaluate the prevalence of fungal sensitisation and its impact on the clinical presentation and outcome of COPD patients. Sensitisation to 17 fungi was studied in 55 COPD patients through skin prick tests, fungus-specific IgE, precipitating antibodies, total IgE and eosinophil counts. The clinical symptoms of patients were monitored thorough a patient-administered questionnaire. Overall, 5.4% (n = 3) of COPD patients were fungus sensitive. The sensitisation was noted to Alternaria alternata and Schizophyllum commune in two patients each, whereas another was sensitive to A. tamarii, Rhizopus spp. and Aspergillus fumigatus. Eosinophils were higher in fungus-sensitised patients (P = 0.001 vs. 0.003). No differences were noted in the clinical presentation of patients sensitised to fungi compared to those not sensitised to fungi or non-atopic. Although low, fungal sensitisation occurs in COPD but it is not limited to Aspergilli alone. Fungus-sensitised patients exhibit greater eosinophilia, implying more severe inflammation. Thus, such patients should be followed up regularly to recognise clinical worsening or development of ABPM.

Aspergillus sensitisation in bidi smokers with and without chronic obstructive lung disease

“…11,13 Recently, Agarwal et al reported sensitisation to non-Aspergillus fungi in three of the 55 (5.5%) COPD subjects studied. 20 The results of these studies suggest that fungal sensitisation does occur in COPD and the differences in prevalence could be related to the method used for the diagnosis of fungal sensitisation (skin testing or fungal-specific IgE or both). We have previously demonstrated that A. fumigatus-specific IgE is more sensitive than Aspergillus skin test for the diagnosis of ABPA.…”

Filamentous Fungi in Respiratory Infections. What Lies Beyond Aspergillosis and Mucormycosis?

“…Also, sensitization against S . commune has been reported in patients with COPD, but the clinical implication of this needs to be established [ 11 ]. Further, FACC is mainly reported from Japan [ 5 ].…”

“…The FBM B . adusta has been shown to colonize the pharynx of susceptible individuals and produce a chronic uneasiness that produces the cough [ 11 ]. In FACC patients, FBM have been found in induced sputum cultures [ 5 ].…”

“…Both conditions respond favourably to oral antifungal agents, thereby proving a definite role of fungi [ 9 , 10 ]. Moreover, new pathophysiological associations hitherto unknown, such as fungal sensitization and ABPM in patients with chronic obstructive pulmonary disease (COPD), are unfolding [ 11 , 12 ]. Further, emergence of resistance in filamentous fungi to azole antifungal drugs used as mainstay of therapy is another challenging scenario witnessed in the last two decades.…”

Epitope Mapping of Rhi o 1 and Generation of a Hypoallergenic Variant

“…For several years, growing investigations have supported the association of particular species of Rhizopus with bronchial asthma and other types of allergy (5)(6)(7)(8)(9)(10). In India, emerging clinical and immunological studies have suggested the involvement of Rhizopus oryzae allergens in type I allergy (11)(12)(13). Rhi o 1 is a major allergen (aspartic protease, molecular mass 44 kDa) of R. oryzae, which causes respiratory sensitization to mold allergic patients (14).…”