RAsp f3 and rAsp f4 are associated with bronchiectasis in allergic fungal airways disease

Abstract

Allergy to thermotolerant filamentous fungi, particularly Aspergillus fumigatus, is closely associated with fixed airflow obstruction, bronchiectasis, and other radiologically defined abnormalities, such as mucus plugging. [1] Woolnough K.F. Richardson M. Newby C. et al. The relationship between biomarkers of fungal allergy and lung damage in asthma. Clin Exp Allergy. 2017; 47: 48-56 Crossref PubMed Scopus (52) Google Scholar However, not all asthma patients who are immunoglobulin E (IgE) sensitized to A fumigatus develop these complications. To identify markers of poor outcomes in fungal allergy with asthma (and cystic fibrosis), the term allergic bronchopulmonary aspergillosis (ABPA) was coined. However, this syndrome was defined largely using criteria that represent a florid immunologic response to A fumigatus rather than clinically relevant outcomes, a problem that remains with the recent modifications recommended by the International Society for Human and Animal Mycology. [2] Woolnough K. Fairs A. Pashley C.H. Wardlaw A.J. Allergic fungal airway disease: pathophysiologic and diagnostic considerations. Curr Opin Pulm Med. 2015; 21: 39-47 Crossref PubMed Scopus (45) Google Scholar Moreover, asthma patients rarely fulfill all criteria for ABPA, whereas fungal allergy in asthma is common, particularly in more severe disease. Denning and colleagues proposed the term severe asthma with fungal sensitization (SAFS), essentially defined as ABPA with a low IgE, to define this larger group. However, not all asthma patients with fungal sensitization have severe disease and not all fungi are associated with lung damage.