Fungi and allergic lower respiratory tract diseases

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:129

Review

Knutsen, Alan P.¹  Bush, Robert K.²  Demain, Jeffrey G.³  Denning, David W.⁴  Dixit, Anupma⁵  Fairs, Abbie⁶  Greenberger, Paul A.⁷  Kariuki, Barbara¹  Kita, Hirohito⁸  Kurup, Viswanath P.⁹  Moss, Richard B.¹⁰  Niven, Robert M.⁴  Pashley, Catherine H.⁶  Slavin, Raymond G.⁵  Vijay, Hari M.¹¹  Wardlaw, Andrew J.⁶ 

[1] St Louis Univ, Div Pediat Allergy & Immunol, St Louis, MO 63104 USA

[2] Univ Wisconsin, Sec Allergy Immunol Pulm Crit Care & Sleep Med, Dept Med, Madison, WI 53706 USA

[3] Allergy Asthma & Immunol Ctr Alaska, Anchorage, AK USA

[4] Univ Manchester, Natl Aspergillosis Ctr, Univ S Manchester Hosp, Manchester Acad Hlth Sci Ctr, Manchester M13 9PL, Lancs, England

[5] St Louis Univ, Dept Internal Med, Div Immunobiol, Sect Allergy & Immunol, St Louis, MO 63104 USA

[6] Univ Leicester, Inst Lung Hlth, Dept Infect Immun & Inflammat, Glenfield Hosp, Leicester, Leics, England

[7] Northwestern Univ, Dept Med, Div Allergy Immunol, Feinberg Sch Med, Evanston, IL 60208 USA

[8] Mayo Clin, Dept Med Allergy & Immunol, Rochester, MN USA

[9] Med Coll Wisconsin, Sect Allergy & Immunol, Milwaukee, WI 53226 USA

[10] Stanford Univ, Dept Pediat, Palo Alto, CA 94304 USA

[11] Hlth Canada, Environm Hlth Directorate, Ottawa, ON K1A 0L2, Canada

关键词: Allergic bronchopulmonary aspergillosis;    allergic bronchopulmonary mycosis;    Aspergillus fumigatus;    Alternaria alternata;    Cladosporium herbarum;    severe asthma with fungal sensitivity;   

DOI  :  10.1016/j.jaci.2011.12.970

来源: Elsevier

【 摘 要 】

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. (J Allergy Clin Immunol 2012;129:280-91.)

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