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Fungi and allergic lower respiratory tract diseases |
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| Authors: | Knutsen Alan P Bush Robert K Demain Jeffrey G Denning David W Dixit Anupma Fairs Abbie Greenberger Paul A Kariuki Barbara Kita Hirohito Kurup Viswanath P Moss Richard B Niven Robert M Pashley Catherine H Slavin Raymond G Vijay Hari M Wardlaw Andrew J |
| Affiliation: | a Division of Pediatric Allergy & Immunology, Saint Louis University, St Louis, Mo b Section of Allergy, Immunology, Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wis c Allergy Asthma & Immunology Center of Alaska, Anchorage, Alaska d National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, United Kingdom e Department of Internal Medicine, Division of Immunobiology, Section of Allergy and Immunology, Saint Louis University, St Louis, Mo f Institute for Lung Health, Department of Infection, Immunity and Inflammation, University of Leicester, Glenfield Hospital, Leicester, United Kingdom g Department of Medicine, Division of Allergy-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Ill h Department of Medicine, Allergy and Immunology, Mayo Clinic, Rochester, Minn i Section of Allergy and Immunology, Medical College of Wisconsin, Milwaukee, Wis j Department of Pediatrics, Stanford University, Palo Alto, Calif k Environmental Health Directorate, Health Canada, Ottawa, Ontario, Canada |
| Abstract: | Asthma is a common disorder that in 2009 afflicted 8.2% of adults and children, 24.6 million persons, in the United States. In patients with moderate and severe persistent asthma, there is significantly increased morbidity, use of health care support, and health care costs. Epidemiologic studies in the United States and Europe have associated mold sensitivity, particularly to Alternaria alternata and Cladosporium herbarum, with the development, persistence, and severity of asthma. In addition, sensitivity to Aspergillus fumigatus has been associated with severe persistent asthma in adults. Allergic bronchopulmonary aspergillosis (ABPA) is caused by A fumigatus and is characterized by exacerbations of asthma, recurrent transient chest radiographic infiltrates, coughing up thick mucus plugs, peripheral and pulmonary eosinophilia, and increased total serum IgE and fungus-specific IgE levels, especially during exacerbation. The airways appear to be chronically or intermittently colonized by A fumigatus in patients with ABPA. ABPA is the most common form of allergic bronchopulmonary mycosis (ABPM); other fungi, including Candida, Penicillium, and Curvularia species, are implicated. The characteristics of ABPM include severe asthma, eosinophilia, markedly increased total IgE and specific IgE levels, bronchiectasis, and mold colonization of the airways. The term severe asthma associated with fungal sensitization (SAFS) has been coined to illustrate the high rate of fungal sensitivity in patients with persistent severe asthma and improvement with antifungal treatment. The immunopathology of ABPA, ABPM, and SAFS is incompletely understood. Genetic risks identified in patients with ABPA include HLA association and certain T(H)2-prominent and cystic fibrosis variants, but these have not been studied in patients with ABPM and SAFS. Oral corticosteroid and antifungal therapies appear to be partially successful in patients with ABPA. However, the role of antifungal and immunomodulating therapies in patients with ABPA, ABPM, and SAFS requires additional larger studies. |
| Keywords: | Allergic bronchopulmonary aspergillosis allergic bronchopulmonary mycosis Aspergillus fumigatus Alternaria alternata Cladosporium herbarum severe asthma with fungal sensitivity |
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