Abstract
The term allergic fungal airways disease has a liberal definition based on IgE sensitisation to thermotolerant fungi and evidence of fungal-related lung damage. It arose from a body of work looking into the role of fungi in asthma. Historically fungi were considered a rare complication of asthma, exemplified by allergic bronchopulmonary aspergillosis; however, there is a significant proportion of individuals with Aspergillus fumigatus sensitisation who do not meet these criteria, who are at high risk for the development of lung damage. The fungi that play a role in asthma can be divided into two groups; those that can grow at body temperature referred to as thermotolerant, which are capable of both infection and allergy, and those that cannot but can still act as allergens in IgE sensitised individuals. Sensitisation to thermotolerant filamentous fungi (Aspergillus and Penicillium), and not non-thermotolerant fungi (Alternaria and Cladosporium) is associated with lower lung function and radiological abnormalities (bronchiectasis, tree-in-bud, fleeting shadows, collapse/consolidation and fibrosis). For antifungals to play a role in treatment, the focus should be on fungi capable of growing in the airways thereby causing a persistent chronic allergenic stimulus and releasing tissue damaging proteases and other enzymes which may disrupt the airway epithelial barrier and cause mucosal damage and airway remodelling. All patients with IgE sensitisation to thermotolerant fungi in the context of asthma and other airway disease are at risk of progressive lung damage, and as such should be monitored closely.
Highlights
Asthma is a common, global condition, affecting more than 300 million people and causing considerable morbidity in adults and children [1]
Alt: Alternaria alternata, Asp: Aspergillus fumigatus, Bot: Botrytis cinerea, Can Candida albicans, Clad Cladosporium herbarum, Muc Mucor racemosus, Pen Penicillium chrysogenum, Pleo: Pleospora bjoerlingii, Seto: Setomelanomma holmii, Stac: Stachybotrys chartarum, Stem: Stemphylium vesicarium, Tri: Trichophyton rubrum, Skin prick tests (SPT): skin prick test, sIgE: specific Immunoglobulin E aAge is given as range for paediatric studies and mean for adult bSeverity based on either original authors description or GINA classification (1/2 mild, 3 moderate, 4–5 severe) cBased on number sensitised to most common fungal allergen dBased on number sensitised to most common between Aspergillus or Penicillium eCohort enriched for fungal sensitised individuals fThe names given here are the currently accepted names for the fungi tested
The term allergic fungal airway disease (AFAD) was conceived with a liberal definition based on IgE sensitisation to thermotolerant fungi and evidence of fungal-related lung damage
Summary
Global condition, affecting more than 300 million people and causing considerable morbidity in adults and children [1]. All patients with IgE sensitisation to thermotolerant fungi in the context of asthma and other airway disease are at risk of progressive lung damage, and as such should be monitored closely.
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
