Fungal allergy in asthma–state of the art and research needs

Clinical and Translational Allergy

Svetlana Sergejeva²  Laurence Delhaes³  Stefano Del Giacco¹  Cendrine Godet⁴  Andrew Wardlaw⁷  Domink Hartl⁵  Catherine Pashley⁷  David W Denning⁶ 

[1] Department of Medical Sciences “M. Aresu”, University of Cagliari, Cagliari, Italy;Translational Immunology Group, Institute of Technology, Tartu University, Tartu, Estonia;Department of Parasitology–Mycology, Regional Hospital Center, Faculty of Medicine, Lille, France;Department of Infectious Diseases, CHU la Milétrie, Poitiers, France;Department of Pediatrics, Infectious Diseases & Immunology, University of Tübingen, Tübingen, Germany;Education and Research Centre, UHSM, Southmoor Road, Manchester M23 9LT, UK;Leicester Institute for Lung Health and Respiratory Biomedical Research Unit, Department of Infection Immunity and Inflammation, University of Leicester, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK

关键词: Hypertonic saline;    Itraconazole;    IgE;    Eosinophil;    Corticosteroid;    ABPM;    ABPA;    SAFS;    Severe asthma;    Aspergillus;   

Others  :  793967
DOI  :  10.1186/2045-7022-4-14

 received in 2013-12-02, accepted in 2014-03-19,  发布年份 2014

【 摘 要 】

Sensitization to fungi and long term or uncontrolled fungal infection are associated with poor control of asthma, the likelihood of more severe disease and complications such as bronchiectasis and chronic pulmonary aspergillosis. Modelling suggests that >6.5 million people have severe asthma with fungal sensitizations (SAFS), up to 50% of adult asthmatics attending secondary care have fungal sensitization, and an estimated 4.8 million adults have allergic bronchopulmonary aspergillosis (ABPA). There is much uncertainty about which fungi and fungal allergens are relevant to asthma, the natural history of sensitisation to fungi, if there is an exposure response relationship for fungal allergy, and the pathogenesis and frequency of exacerbations and complications. Genetic associations have been described but only weakly linked to phenotypes. The evidence base for most management strategies in ABPA, SAFS and related conditions is weak. Yet straightforward clinical practice guidelines for management are required. The role of environmental monitoring and optimal means of controlling disease to prevent disability and complications are not yet clear. In this paper we set out the key evidence supporting the role of fungal exposure, sensitisation and infection in asthmatics, what is understood about pathogenesis and natural history and identify the numerous areas for research studies.

【 授权许可】

   
2014 Denning et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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