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Allergic fungal airway disease: pathophysiologic and diagnostic considerations.
[allergic bronchopulmonary aspergillosis]
Fungal
spores
are
ubiquitously
present
in
indoor
and
outdoor
air
.
A
number
can
act
as
aeroallergens
in
Immunoglobulin
E
(
IgE
)
-
sensitized
individuals
and
some
thermotolerant
fungi
germinate
in
the
lung
where
they
can
cause
a
combined
allergic
and
infective
stimulus
leading
to
a
number
of
clinical
presentations
characterized
by
evidence
of
lung
damage
.
We
discuss
which
biomarkers
are
useful
in
helping
to
guide
diagnosis
,
prognosis
and
treatment
of
allergic
fungal
airway
disease
(
AFAD
)
.
Diagnostic
biomarkers
,
such
as
specific
IgEs
and
fungal
culture
,
for
AFAD
are
limited
by
sensitivity
,
although
this
may
be
improved
with
novel
agents
such
as
specific
IgEs
to
fungal
components
and
quantitative
PCR
.
Total
IgE
and
hypereosinophilia
are
nonspecific
and
do
not
clearly
relate
to
disease
activity
.
High
attenuation
mucus
and
proximal
bronchiectasis
are
specific
,
albeit
insensitive
markers
of
AFAD
.
Biomarkers
that
predict
prognosis
and
treatment
response
are
yet
to
be
defined
.
This
review
summarizes
the
fungi
involved
and
the
current
debate
regarding
the
diagnostic
criteria
to
define
fungal-associated
lung
disease
.
We
advocate
the
phasing
out
of
the
term
allergic
bronchopulmonary
aspergillosis
and
the
use
of
a
more
inclusive
term
such
as
AFAD
,
together
with
a
more
liberal
set
of
criteria
based
largely
on
IgE
sensitization
to
thermotolerant
fungi
,
which
identifies
those
patients
at
risk
of
developing
lung
damage
.
